Josette Covington
Claymont,DE
Summary
Business-oriented Medical Director and Internal Medicine physician specializing in patient outcomes and healthy service delivery models. Extensive patient care and medical executive leadership in the fields of Occupational Medicine, public health, utilization management, and as a Medical Review Officer. 3+ years of experience in Medicare concurrent and retrospective reviews. Board-Certified in General Preventive Medicine.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Medical Director
Highmark Health
02.2024 - Current
- Plays key role on multidisciplinary Medical Management team to implement current strategies for plan members and improve health outcomes
- Conducts utilization management of member cases using CMS Medicaid guidelines, state regulations, and plan policies
- Initiates medical investigations on potential quality of care incidents involving members
- Determines outcomes of medical and pharmaceutical appeals cases
- Provides medical expertise and physician leadership on organizational committees and Quality Improvement initiatives
Regional Medical Director
PIVOT OCCUPATIONAL HEALTH
01.2021 - 01.2024
- Provides clinical leadership and medical oversight for six Delaware and Maryland clinics, ensuring adherence to budget goals, safety guidelines, and patient volume metrics
- Serves as key member of Executive leadership team: develops strategies and initiatives for the organization, generates budget targets, and creates department policies and procedures
- Leads medical operations and oversight of physicians and allied health professionals, including staff recruitment, credentialing and continuing education, and communication of department standards
- Evaluates medical staff through semi-annual performance reviews, development of performance improvement programs, and making recommendations for merit-based salary increases
- Supervises the organization’s drug screening program and acts as lead Medical Review Officer.
Center Medical Director
CONCENTRA URGENT CARE
12.2019 - 03.2021
- Provided clinical leadership of patient care and medical operations by analyzing provider efficiency and clinic performance based on company-specific goals and initiatives
- Served as key thought leader for center leadership team, working collaboratively with center operations director and center therapy director to create clinic goals and initiatives
- As part of Executive Leadership team, created new patient safety standards and infectious disease protocols to address the COVID-19 pandemic.
Staff Physician
PIVOT OCCUPATIONAL HEALTH
01.2012 - 12.2019
- Provided direct patient care for work-related injuries, industrial screenings, & physical examinations
- Performed Civil Surgeon examinations of foreign nationals for United States residency
- Conducted SSA Disability Consultative Evaluations using Official Disability Guidelines (ODG)
- Performed Medical Review Officer evaluations of positive drug screens.
Physician Consultant
EXECUTIVE HEALTH RESOURCES
08.2009 - 10.2012
- Performed concurrent and retrospective clinical reviews of hospital admission levels to ensure compliance with CMS benchmarks
- Provided medical necessity consultations for hospital medical staff and utilization management departments to maximize hospital’s acceptance rates for inpatient billing
- Made status determinations for hospitalized patients using InterQual, DRGs, and McKesson criteria
- Collaborated with physicians via peer-to-peer conferences to evaluate patient care quality and efficiency.
Education
Internal Medicine Resident
Temple University Hospital
PhiladelphiaMaster of Public Health -
Johns Hopkins University School of Public Health
Baltimore, MDDoctor of Medicine -
Perelman School of Medicine At The University of Pennsylvania
Philadelphia, PABachelor of Arts - Psychology
Northwestern University
Evanston, ILTemple University Hospital
Philadelphia, PASkills
- Utilization Management
- Medicare Reviews
- Executive Leadership
- Physician Supervision
- Medical Review Officer
- Direct Patient Care
- Clinical Research
- Medical Operations
Publications
- Covington J. Securing reimbursement for preventive medicine services. JNMA 2004;96(10):1265.
- Covington J. Smoking Contributes to Almost All Cancer Deaths in Black Men. JNMA 2004;96(10):1270.
- Covington JP and Grisso JA. Assessing cardiovascular disease risk in women: a cultural approach. JNMA 2001;93(11):430-435.
- Bressler J, Ansell D, Parker (Covington) J. Breast cancer screening in an urban public hospital. Cancer 1993;72:3636-40.
Certification
- Board Certification: American Board of Preventive Medicine
- Xcel Physician Executive Leadership Program
- Certification: Medical Review Officer Certification Council
- Civil Surgeon, U.S. Department of Homeland Security
- Certified DOT Medical Examiner, FMCSA
- Delaware Medical License, C1-0007336
- Maryland Medical License, D0055049
- Pennsylvania Medical License, MD421010
Timeline
Medical Director
Highmark Health
02.2024 - Current
Regional Medical Director
PIVOT OCCUPATIONAL HEALTH
01.2021 - 01.2024
Center Medical Director
CONCENTRA URGENT CARE
12.2019 - 03.2021
Staff Physician
PIVOT OCCUPATIONAL HEALTH
01.2012 - 12.2019
Physician Consultant
EXECUTIVE HEALTH RESOURCES
08.2009 - 10.2012
Internal Medicine Resident
Temple University Hospital
Master of Public Health -
Johns Hopkins University School of Public Health
Doctor of Medicine -
Perelman School of Medicine At The University of Pennsylvania
Bachelor of Arts - Psychology
Northwestern University
Temple University Hospital