HOPE STARKMAN, MD, FACR
Lake Worth,FL
Summary
Board-certified Rheumatologist and Managing Medical Director with 30+ years of experience in private practice and insurance environments. Demonstrated expertise in operational leadership, medical necessity case reviews, and specialized rheumatology care. Skilled in MCG, OCG, CAS/COS, JIRA, and OKTA for effective management of pharmacy claims and biologic medication appeals. Strong understanding of OSHA and HIPAA regulations, with a history of developing tailored treatment plans and ensuring high standards of patient care. Experienced in fast-paced environments and adaptable to last-minute changes. Thrives under pressure and consistently earns high marks for work quality and speed.
Overview
32
32
years of professional experience
Work History
Managing Director
Guardian Angel Rheumatology Reviews, PA
Lake Worth, FL
12.2023 - Current
- Conducted peer reviews to ensure fair and accurate coverage decisions across multiple companies.
- Assessed 50 to 75 complex medical cases monthly for independent medical review agencies.
- Evaluated and documented 80 to 100 cases monthly, focusing on medications and disability claims.
- Processed rheumatology and biologic appeals to facilitate appropriate patient access.
- Analyzed pharmacy claims for compliance with regulations across various insurance providers.
- Reviewed medical necessity cases for radiography, inpatient stays, and specialized lab tests.
- Completed rigorous training in OSHA, HIPAA, and Medicare Fraud and Abuse for security clearance.
- Developed documentation templates while collaborating with medical teams to enhance operational efficiency.
Medical Director Position/Medical Reviewer
Oscar Healthcare
06.2023 - Current
- Reviewed pharmacy claims for medical necessity across multiple forums.
- Collaborated with CVS utilizing COS/CAS system, JIRA, OKTA, and PA Hub.
- Operated daily on MacBook while adapting to various computers.
- Adapted swiftly to frequent software changes implemented by Oscar.
- Utilized Slack for communication; experienced with Microsoft Teams as well.
- Executed all Rheumatology appeals for states contracted with company.
- Conducted utilization management reviews for emergency room to inpatient level of care.
- Assessed medical necessity for rehabilitation/SNF and various levels of care.
Managing Director
Ocean Ridge Arthritis Associates, PA
Boynton Beach, FL
05.2000 - 01.2023
- Oversaw operations of private rheumatology practice, managing clinical services and staff employment.
- Delivered specialized care by diagnosing and treating autoimmune and musculoskeletal conditions.
- Incorporated acupuncture into treatment plans to enhance patient outcomes.
In-House Rheumatologist
Medical Center Affiliates
Boca Raton, FL
07.2013 - 11.2019
- Executed personalized treatment plans integrating pharmacological therapies and lifestyle modifications.
- Maintained positive, empathetic interactions with patients to address concerns promptly.
- Implemented protocols for early detection and intervention of rheumatic diseases, reducing rapid progression risk.
Employed Rheumatologist
Rheumatology Associates of South Florida
08.1995 - 01.2000
- Provided clinical rheumatology services in large multicounty, single-specialty practice.
Participated in several clinical trials to support research initiatives.
Transitioned to my own private practice after birth of triplets.
In-House Rheumatologist/Hospital Employed
North Broward Medical Center
01.1994 - 01.1995
- Employed by large hospital district to establish newly launched Arthritis Center following completion of rheumatology fellowship
Education
Fellowship - Rheumatology
Montefiore Medical Center/Albert Einstein College of Medicine
Bronx, N.Y.06.1994
Residency - Internal Medicine
Beth Israel Medical Center
New York, N.Y.06.1992
Internship - Internal Medicine
Beth Israel Medical Center/Mount Sinai Medical Center
New York, N.Y.06.1990
Doctor of Medicine -
Albany Medical College
Albany, N.Y.05.1989
Bachelor's Degree -
Barnard College Columbia University
New York, N.Y.05.1985
High School - Premedical Studies
Hillcrest High School
Jamaica, NY06.1981
Skills
- Insurance Company Medical Director
- Medical Peer Reviewer
- Utilization Review Specialist
- Coding and Billing
- Medical Practice Management
- Clinical Governance
- Patient Safety & Compliance
- Strategic planning
- Leadership
- HIPAA Certified
- OSHA trained
- QA
- Patient Education
- Hiring Employees
Board Certification ABIM Rheumatology 141793 1994 renewed 2024-2024
Phone (Cellular)(561) 252-7575
Fasc (561) 736-8499
Primary Residence
4075 Arthurium Avenue, Lake Worth, FL, 33462
Secondary Residence
512 Skyview Drive, Ellijay, GA, 30536
Academic Teaching Experience
Nova Southeastern College of Osteopathic Medicine, Clinical Instructor/Lecturer/Preceptor, Clinical Assistant Professor of Rheumatology
Medical Staff Privileges
Baptist Healthcare, Bethesda Memorial Hospital 2815 S. Seacrest Blvd., Boynton Beach, FL, 33435, 01/01/95, present, (561) 737-7733
Languages
English
Full Professional
Spanish
Professional
Medical Licenses
State Medical Licensure, Arizona, 71352, 03/10/24, 02/07/28, California, G194212, 02/27/24, 12/31/26, Florida, ME0063441, 12/31/24, 01/31/26, New York, 183685-1, 09/30/26, North Carolina, 2024-00035, 10/07/26, Texas, V4506, 10/18/24, 10/22/26, Georgia, 105665, 08/14/25, 10/31/27
References
- References available upon request
Timeline
Managing Director
Guardian Angel Rheumatology Reviews, PA
12.2023 - Current
Medical Director Position/Medical Reviewer
Oscar Healthcare
06.2023 - Current
In-House Rheumatologist
Medical Center Affiliates
07.2013 - 11.2019
Managing Director
Ocean Ridge Arthritis Associates, PA
05.2000 - 01.2023
Employed Rheumatologist
Rheumatology Associates of South Florida
08.1995 - 01.2000
In-House Rheumatologist/Hospital Employed
North Broward Medical Center
01.1994 - 01.1995
Fellowship - Rheumatology
Montefiore Medical Center/Albert Einstein College of Medicine
Residency - Internal Medicine
Beth Israel Medical Center
Internship - Internal Medicine
Beth Israel Medical Center/Mount Sinai Medical Center
Doctor of Medicine -
Albany Medical College
Bachelor's Degree -
Barnard College Columbia University
High School - Premedical Studies
Hillcrest High School
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