Deepa Dave
Sugar Land,TX
Summary
Dynamic Medical Director with extensive experience at Aetna, a CVS Health, excelling in clinical program development and utilization management. Proven ability to enhance medical management through expert appeals review and effective communication. Recognized for fostering teamwork and delivering high-quality healthcare solutions in fast-paced environments. Board Certified in Internal Medicine.
Overview
27
27
years of professional experience
Work History
Medical Director
Aetna, a CVS Health
05.2022 - Current
- Provided oversight for medical policy implementation.
- Participated in the development, implementation, and evaluation of clinical / medical programs to expand Aetna's medical management programs
- Supported the Medical Management staff ensuring timely and consistent responses to members and providers.
- Oversaw utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations including Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
- Provided clinical, coding, and reimbursement expertise. Also, directed case management when necessary.
- Provided clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
Physician Advisor
Versalus Health
08.2020 - 03.2022
- Performed focused real time and post discharge case reviews on various EMR platforms to present salient clinical features in hospital admissions while utilizing proficiency with various EMRs, expansive clinical knowledge and excellent verbal communication.
- Maintained up-to-date knowledge on industry trends and regulations, ensuring accurate advice was provided to clients at all times.
- Developed strong rapport with colleagues and staff members, promoting teamwork within the workplace. Improved results by developing detailed presentations on each case tailored towards claim processing.
Acute Care Hospital Medicine
CHI St. Luke's Health - Baylor St. Luke's Medical Center
02.2014 - 07.2020
- Inpatient hospital practice involving acute care management of hospitalized patients on Medical, Surgical, Post-op, Step-down and Intensive Care Units.
- Provided patient care in Skilled Nursing facilities, Acute Rehabilitation Hospital, Acute Long-term Care Hospital. Worked effectively in fast-paced environments.
Consultant Physician
Changi General Hospital
01.2011 - 12.2013
- Delivered high-quality healthcare services in Ambulatory and in In-patient settings to patients with complex medical conditions in a fast-paced environment while maintaining strong working relationships with colleagues, students, residents and fellows in a teaching and supervisory role at the academic institution.
- Offered didactic sessions on various internal medicine topics and conducted medical mortality rounds with residents and fellows
Critical Care Training
Lilawati Hospital and Research Center
03.2009 - 09.2009
- Received training in the medical management of critically ill patients in ICU
Primary Care Provider
Kelsey Seybold
01.2005 - 08.2006
Associate Physician
Plainfield Health Care Center
07.2001 - 10.2004
- Provided healthcare services and preventive care for underserved populations
Urgent Care Physician
EMO Medical Care
01.2000 - 01.2001
- Provided Acute medical care to patients with minor illnesses and injuries
Attending Physician
Roosevelt Care Center
03.1998 - 01.2000
- Provided Medical care to patients in Skilled Nursing Facility
Education
M.D. - Otolaryngology
Grant Medical College And J.J. Hospital
Mumbai, India02-1993
M.D. - Medicine
Topiwala National Medical College
Mumbai, India 01-1990
Skills
Clinical Practice and Health Care Industry
Utilization Management with Commercial Health Plan and Medicare
Appeals Review
Appeals Panel Hearing
Physician Advisor in a Healthcare system
Board Certification in Internal Medicine
Timeline
Medical Director
Aetna, a CVS Health
05.2022 - Current
Physician Advisor
Versalus Health
08.2020 - 03.2022
Acute Care Hospital Medicine
CHI St. Luke's Health - Baylor St. Luke's Medical Center
02.2014 - 07.2020
Consultant Physician
Changi General Hospital
01.2011 - 12.2013
Critical Care Training
Lilawati Hospital and Research Center
03.2009 - 09.2009
Primary Care Provider
Kelsey Seybold
01.2005 - 08.2006
Associate Physician
Plainfield Health Care Center
07.2001 - 10.2004
Urgent Care Physician
EMO Medical Care
01.2000 - 01.2001
Attending Physician
Roosevelt Care Center
03.1998 - 01.2000
M.D. - Otolaryngology
Grant Medical College And J.J. Hospital
M.D. - Medicine
Topiwala National Medical College
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