MARNI NICHOLAS
Jupiter,FL
Summary
Board-Certified Internal Medicine Physician and MBA-trained healthcare executive with 15+ years of leadership experience in Primary Care, Medicaid and Medicare managed care. Proven expertise in utilization management, medical necessity review, cost-of-care reduction, and population health strategy across large, complex member populations (>700,000 lives). Experienced in clinical policy development, regulatory compliance, and collaboration with executive leadership to drive quality, affordability, and growth. Recognized for leading high-impact initiatives that improve outcomes, optimize utilization, and ensure compliance with CMS and state regulations.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Medical Director of Clinical Programs
ELEVANCE HEALTH
Tampa, FL
08.2019 - Current
- Serves as senior clinical liaison to regional Medicare leadership, overseeing clinical quality and program performance, supporting business development and growth, and developing relationships with value based clinical partners
- Leads cost-of-care reduction strategies, identifying and implementing initiatives impacting utilization, network performance, and medical expense trends.
- Partners with regulatory and compliance stakeholders to ensure adherence to CMS and state requirements
- Oversees clinical vendor performance, ensuring quality, efficiency, and alignment with organizational goals
- Ideated and implemented multiple novel initiatives leading to over $10 million in identified savings
Plan Performance Medical Director
ELEVANCE HEALTH
Tampa, FL
08.2019 - 01.2025
- Led utilization management (UM) activities, including prior authorization, medical necessity review, and appeals for a Medicaid population of 700,000+ members
- Ensured evidence-based decision-making and inter-rater reliability across physician reviewers
- Participated in grievances and appeals processes, ensuring regulatory compliance and timely resolution
- Contributed to medical policy development and implementation
- Medical Director for Clear Health Alliance, the Florida HIV/AIDS Medicaid Managed Care product, leading a multidisciplinary team of physicians, case managers, finance specialists, and nurses to improve population health outcome metrics, quality of life, and cost of care in the HIV/AIDS population.
- Spearheaded multiple cost-of-care initiatives and population health management initiatives, including emergency room utilization, hemodialysis cost, and non-emergency transportation, resulting in measurable improvements in outcomes and reductions in cost of care
- Medical Director for Special Investigations Unit, reviewing quality of care and evaluating for fraud, waste, and abuse
- Member of Medical Executive Committee, creating and evaluating care and reimbursement policies
Physician, Occupational Health
THE WALT DISNEY COMPANY
Orlando, FL
05.2018 - Current
- Per diem physician at Disney Health Services, the occupational medicine clinic at Walt Disney World.
- Treats on-the-job and work-related injuries and illnesses
- Performs DOT clearance and physicals
- Performs fitness for duty exams and workers compensation exams
Medical Director
JUPITER MEDICAL SPECIALISTS
Jupiter, FL
11.2018 - 08.2019
- Medical director of a multispecialty group consisting of primary care, surgery, radiation oncology, nephrology, and gynecology practices
- Pioneered development and implementation of chronic care management program
- Responsible for clinical oversight of all practices and clinicians
- Responsible for creation of clinical algorithms and practice policies
- Responsible for oversight of MIPS/MACRA data collection and submission
Medical director
JUPITER MEDICAL CENTER URGENT CARE
Jupiter, FL
11.2015 - 08.2019
- Medical director of multiple urgent care centers, supervising multiple mid-level providers.
- Oversees and reviews clinical care protocols, develops educational programs and protocols for providers.
- Responds to patient feedback and concerns.
Attending Physician
PRIMARY CARE SERVICES OF JMS
Jupiter, FL
09.2015 - 08.2019
- Built and scaled a primary care practice to 3,000+ patients, achieving strong patient retention and operational performance
Attending Physician
BEACON INTERNAL MEDICINE
Portsmouth, NH
07.2004 - 08.2015
- Physician in a primary care practice consisting of approximately 6,000 patients, and attending physician at Portsmouth Regional Hospital.
- Created multiple innovative and successful programs, such as the Beacon Internal Medicine Exercise Initiative, a program that trained over 500 community members to run a 5K race, and a multi-group walk-in urgent care program.
Chief Resident, Department of Internal Medicine
ST. VINCENT’S HOSPITAL AND MEDICAL CENTER
Manhattan, New York
07.2003 - 06.2004
- Managed Internal Medicine Residency Program of a major metropolitan hospital with over 100 internal medicine and medicine-pediatrics residents.
- Served as attending physician in Internal Medicine Clinic and supervised interns and residents in outpatient management.
- Instructed second- and third-year medical students in physical diagnosis, history taking, case write-up, and presentation skills.
- Constructed monthly and annual schedules for residents, interns, and attendings.
- Interceded in disciplinary issues among house staff.
Medical Resident, Internal Medicine Primary Care Track
ST. VINCENT’S HOSPITAL AND MEDICAL CENTER
Manhattan, New York
07.2000 - 06.2003
- Delivered patient care in acute hospital situations and outpatient clinic as House Officer.
- Instructed interns and medical students in patient management and presentation skills.
Education
Physician Executive MBA -
AUBURN UNIVERSITY
05-2020
Doctor of Medicine - undefined
UNIVERSITY OF ROCHESTER
Rochester, New York05-2000
Bachelor of Arts - Psychology
UNIVERSITY OF ROCHESTER
Rochester, New York05-1996
Skills
- Utilization Management (UM)
- Prior Authorization
- Medical Necessity Review
- Appeals & Grievances
- Medicaid & Medicare Managed Care
- Cost of Care Strategy
- Population Health
- HEDIS & Quality Metrics
- Medical Policy Development
- Regulatory Compliance (CMS/State)
- Fraud, Waste & Abuse (SIU)
- Value-Based Care
- Provider Engagement
Certification
- American Board of Internal Medicine (Board Certified)
- Lean Six Sigma Green Belt
- Professional Ethical Leadership Certification
- DOT Certified Examiner
- Active Medical Licenses: FL, NC, SC, GA, AL, NJ, NY, ME, NH, CT
- BLS Certified
Timeline
Medical Director of Clinical Programs
ELEVANCE HEALTH
08.2019 - Current
Plan Performance Medical Director
ELEVANCE HEALTH
08.2019 - 01.2025
Medical Director
JUPITER MEDICAL SPECIALISTS
11.2018 - 08.2019
Physician, Occupational Health
THE WALT DISNEY COMPANY
05.2018 - Current
Medical director
JUPITER MEDICAL CENTER URGENT CARE
11.2015 - 08.2019
Attending Physician
PRIMARY CARE SERVICES OF JMS
09.2015 - 08.2019
Attending Physician
BEACON INTERNAL MEDICINE
07.2004 - 08.2015
Chief Resident, Department of Internal Medicine
ST. VINCENT’S HOSPITAL AND MEDICAL CENTER
07.2003 - 06.2004
Medical Resident, Internal Medicine Primary Care Track
ST. VINCENT’S HOSPITAL AND MEDICAL CENTER
07.2000 - 06.2003
Doctor of Medicine - undefined
UNIVERSITY OF ROCHESTER
Bachelor of Arts - Psychology
UNIVERSITY OF ROCHESTER
Physician Executive MBA -
AUBURN UNIVERSITY
LEADERSHIP EXPERIENCE
- BLUE OCEAN QUALITY ALLIANCE March 2018 – August 2019
- Chair, Quality Committee and Member, Finance Committee
- Chair of the Quality Committee for the Blue Ocean Quality Alliance, a new multi-hospital ACO.
- In charge of creating clinical protocols for compliance with Medicare Shared Savings Program, leading and motivating physician groups to join, participate, and comply with the program.
- FLORIDA MEDICAL ASSOCIATION October 2018 – August 2019
- Fellow, Karl M. Altenberger Leadership Academy
- Chosen to be a fellow for an intensive 10-month program to foster leadership skills.
- PORTSMOUTH REGIONAL HOSPITAL DEPARTMENT OF MEDICINE 2006 - 2011
- Vice-Chair, Department of Medicine
- Elected leader of the Department of Medicine.
- Chair of Bylaws Committee, member of Risk Management and Utilization Management committees
- Helped lead the Department of Medicine through its transition to a hospitalist program and developed programs to integrate outpatient community physicians with the hospital.
- Member of the Medical Executive Committee
- SEACARE HEALTH SERVICES, Exeter, New Hampshire 2005 - 2007
- Executive Board Member
- Served on the Executive Board of SeaCare, an organization that provides medical care for uninsured adults.