Chief Medical Officer (Middle East, India & Africa)
ALLIANZ WORLDWIDE CARE
Total years of experience :26 years, 7 Months
Responsible for providing leadership and clinical expertise for AWC’s business in the GCC, Africa and Indian subcontinent; for driving the overall clinical strategy ensuring cost efficient appropriate care for members.
Responsible for the development, implementation & promotion of health services strategies, tactics, policies & programs (Utilization Management, Quality Management, Network Management, Clinical coverage policies) to drive cost effective delivery of quality healthcare & establish competitive advantage including contributing to the creation, implementation & communication of strategic plans & operating plans.
* Liaise with Clinicians & providers to find solutions for complex non-standard medical cases; with regulatory & accrediting agencies; Participate in internal & external health industry development efforts; Represent Aetna in market, community & best-practice forums.
* Negotiate in complex, large-stake situations, adapt diverse negotiation styles, analyse impacts of various options.
* Integrate data from multiple sources into a logical framework that supports decision-making for clinical programs, Utilization & cost trends, & Clinical standards; use data to strengthen business cases by presenting the logical flow of data, interpretations, & recommendations.
* Undertake vendor selection based on sound selection criteria; Manage 3rd party contractual deliverables in compliance with budget & standards; Monitor ongoing effectiveness of strategic relationships against plan; take appropriate action to realize results.
* Shape product coverage and business policy by advocating for changes consistent with evolving clinical data & market trends; design & promote consistent methodology to drive disciplined analysis of clinical impact.
* Institutionalize compliance as a core competence, follow fair and ethical practices, and commit to integrity.
* Develop adaptable workforce, drive engagement, build and inspire internal capability, and create a culture of continuous improvement.
Director - International Health Advisory Team (ME, Africa, & Asia Pacific)
Responsible for strategic & operational direction for performance based medical management to 3 small medical teams in Dubai, Shanghai, & Hong Kong; handled a portfolio of 60, 000 members. After AGB acquired Goodhealth in Dec 2007, successfully led the integration initiatives e.g. network re-contracting, re-branding, process integration, & realigning the strategic direction to ensure planned synergies are achieved.
Key Achievements
* Institutionalized consistent & effective use of standardized evidence based medical necessity tools by using resources like Milliman Care Guidelines, Clinical Policy Bulletins, Agency for Healthcare Research & Quality & Central Guidelines Clearinghouse.
* Expanded directly contracted provider network in ME, Africa & Asia by 35% in FY 2008 & FY 2009 through regular interaction with medical directors, legal teams, CEOs, CFOs & regulators using comprehensive experience of negotiating & maintaining complex & competitive provider contracts.
* Implemented improved provider education policies and guidelines by sharing performance data with providers which achieved agreement & successfully implemented wide range of mutually beneficial performance improvement action plans.
* Improved provider network pricing by 14% as a result of negotiation, timely reimbursement, & relationship management in FY 2008 & FY 2009.
GOODHEALTH WORLDWIDE, DUBAI, UAE MAR 2005 - OCT 2007
Goodhealth, formed in 1980, was a part of the UK based Primary Group was a leading & specialist provider of international medical insurance. AGB acquired Goodhealth in Dec 2007.
Senior Manager- Medical Resources & Provider Relations
Handled a portfolio of 35, 000 members in Middle East, Africa & India, & efficiently delivered key elements of medical management strategy including turn around time for elective cases of 2 business days with + 98% accuracy. Developed preferred provider network as a core competitive advantage for business retention & expansion strategy which grew by 165% from Mar 05 - Dec 2007.
PARAMOUNT (MUNICH RE) HEALTH SERVICES, MUMBAI, INDIA 2000 - 2003
Premier health insurance intermediary in India - was a joint venture with Munich Re, Germany.
Manager- Medical Management
Introduced to insurance medicine as a career option, built a strong foundation of all aspects of health insurance helped the organization to become a leading national TPA in India.
GENERAL PRACTICE 1998 - 2000
Clinical management of basic medical problems across all areas including ER.
KING EDWARD VII MEMORIAL HOSPITAL, MUMBAI 1996 - 1998
Administrative Medical Officer
General Practice, General Healthcare administration in a large university hospital.
* Masters of Business Administration - Healthcare Management 2004 Queen Margaret University College, United Kingdom; 1 year full time programme accredited by British Quality Assurance Agency for Higher Education & European Health Professionals Council.
* Bachelor of Medicine & Bachelor of Surgery 1995 Seth G. S. Medical College, Mumbai - one of the top ranked medical schools in India.