Vipul Patel
Healthcare Executive: Medical Director, Physician, Consultant, Senior Manager Qualified | DO, MBA, BS | Success in Clinical Operations Improvement, Patient Care Optimization & Product Commercialization
- Role
- Medical Director at Baylor Scott & White Health
- Location
- Austin, TX, US
- LinkedIn followers
- 500 followers
Experience
Medical Director
Mar 2022 — Present · Austin, TX, US
OVERVIEW:Provide clinical / business subject matter expertise to health plan teams (member services, provider relations, benefits configuration, claims management, utilization management) to ensure appropriate cost-effective healthcare delivery for federal, state, group, and individual insurance plan members. Institute data driven initiatives to improve population outcomes by focusing on affordability, quality, and member / provider experience. Efforts resulting in a 30% increase in plan membership to members within the last 2 years.HIGHLIGHTS: Data and Informatics – Program management of benefits / prior authorization code configuration process; Data analysis to implement changes in prior authorization process to reduce provider administrative burdens and reduce resource utilization; Contribute to the development and implementation of cloud-based applications and dashboards to help automate key processes and reduce prior authorization / claims payment pain points for providers and members. Medical Policy Management - Update and develop medical policies to adhere to established evidence-based clinical guidelines and mandates / requirements / benchmarks set forth by CMS, NCQA, HHSC, and Texas Department of Insurance. Utilization management – Perform concurrent, retrospective, prior authorization, and appeals reviews to ensure quality, safe, cost-effective, and timely healthcare service delivery; educate providers and assess need for medical policy changes through peer-to-peer case discussions / reviews. Wellness and Quality – provide clinical support for the development of digital health coaching tools and population health quality outcomes; deliver webinars to members and providers regarding chronic condition management and various wellness / prevention topics; update and incorporate prevention and screening guidance based on HEDIS measures, CDC / USPSTF / ACIP / Bright Futures recommendations.
Education
Touro University Nevada
Doctor of Osteopathic Medicine (DO)
The University of Texas at Austin - Red McCombs School of Business
Master of Business Administration - MBA
Rutgers University
Bachelor of Science (BS)
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