Gerald Chavez, D.C.

Experienced Utilization Management/Peer Review professional with active Chiropractic State Licenses in CA, CO, MN, ND, and NJ. Seeking Chiropractic Clinical Review position.

• Through the research of the scientific literature and individual state’s Statutes and Regulations, assisted in the development of Clinical Practice Guidelines. These Guidelines, which must comply with the state’s Statutes and Regulations, and often meet with the state association’s approval (ie, California Chiropractic Association, New York Chiropractic Association…), are then used to set boundaries of medical necessity and covered and non-covered services.
• Assisted in the development, testing and presentation of Provider Performance Summary (PPS) tool. This tool provided a suite of reports that compared the individual practitioner’s treatment efficiency metrics to both network and national peer performance standards.
• Assisted in the testing and presentation of the Variable Intensity Utilization Management categorization. From the information contained in the PPS noted above, the practitioner is placed in one of three categories which dictated the level of utilization management.
• Organized a suite of outcome assessment tools available to panel practitioners via our website. This required research of scientific literature, contacting the authors of the individual outcome tools and obtaining their permission to make them available to our panel providers.

• 1994, California Chiropractic Association / California Chiropractic Foundation, Certified Industrial Disability Examiner
• 1995, State of California Division of Workers Compensation, Qualified Medical Evaluator (QME)
• 1997, State of California Employment Development Department (EDD), Independent Medical Examiner
• 2011-14, Utilization Management Committee (UMC)

Prior to my employment with eviCore Healthcare I was the owner/manager of Chavez Chiropractic Clinic. Interviewed, examined, diagnosed and treated patients for a variety of musculoskeletal conditions. Ancillary: Performed over 200 Qualified Medical Evaluations for the California Workers Compensation system. This requires the analysis of quantitative and qualitative information from several sources in order to identify and address key issues, draw conclusions and recommend a course of action on a variety of complex medical / legal issues. Performed over 150 IME examinations for the State of California Employment Development Department.

In addition, more than 1000 hours of continuing education since graduation.