Ronald Fujimoto
Honolulu,USA
Summary
Directed service integration and quality oversight for Quest Integration Program, encompassing medical, behavioral health, and long-term services and supports (LTSS). Led interdisciplinary team meetings to optimize care transitions across the continuum. Championed clinical leadership initiatives to elevate quality outcomes and operational excellence within medical management team.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Regional Chief Medical Officer
Hawaii Health System Corporation Kauai Region
Waimea, HI
07.2020 - Current
- Directed clinical operations, ensuring compliance with healthcare regulations and standards.
- Developed strategic initiatives to enhance patient care quality and operational efficiency.
- Collaborated with multidisciplinary teams to implement evidence-based practices in patient treatment protocols.
- Oversaw budget management, optimizing resource allocation to improve service delivery across departments.
- Led recruitment and training programs for medical staff, fostering professional development and retention.
- Analyzed patient outcomes data to identify areas for improvement in clinical services and interventions.
- Advocated for policy changes at regional healthcare committees to address emerging health challenges effectively.
- Improved patient outcomes and delivery of care through improved clinical quality processes.
- Applied continuous process improvement strategies to enhance case management, programs and clinical management.
- Drove significant improvement in achievement of goals related to health, safety and employee relations.
- Defined medical and administrative best practices in policies and procedures.
- Created effective marketing plans to attract new patients to practice.
- Led diverse team of medical and administrative professionals in day-to-day clinic activities such as patient care, new business development, and patient relations.
- Mentored aspiring leaders within the organization, providing guidance career development opportunities.
- Spearheaded initiatives for continuous improvement in patient safety, resulting in reduced infection rates and medical errors.
Chief Medical Officer (Full Time)
UnitedHealthcare Community Plan
Honolulu, Hawaii
06.2012 - 06.2020
- Lead clinical program operations of key quality, preventive health, and health services department activities and service coordination to confirm quality and timely care is delivered to members
- Address potential quality of care issues, peer review activities, and oversee all QAPI activities
- Medical Director for Long Term Services and Support, including Home and Community Based Services
- Participate in all DHS-initiated meetings, including but not limited to DHS Medical Director meetings and Provider Advisory Board meetings
- Health plan liaison to and key contact for MQD Medical Director
- Develop and implement utilization management, disease management, and quality management strategies to serve members and providers who are part of the QUEST Integration and D-SNP programs
- Oversee all credentialing and recredentialing activities of all provider types, including medical, behavioral health and LTSS service providers
Medical Director, Quality Management (Full Time)
Blue Cross and Blue Shield Association
Honolulu, Hawaii
09.2005 - 06.2012
- Responsible for quality of care and total quality management in network of over 2,000 physicians, and more than 670,000 Medicaid, Medicare and commercial members of the Hawaii Medical Service Association (HMSA) health plan. HMSA is an independent licensee of Blue Cross and Blue Shield Association.
- Led all HEDIS improvement initiatives and achieved 4 Star Rating in 2013 (2011 year data) for the HMSA health plan
- Responsible for oversight of Quality Assurance and Grievances for all lines of business
- Served as HMSA Patient Safety Officer and implemented patient safety initiatives, developing strategies for zero tolerance member safety programs
- During tenure as HMSA Health Plan Hawaii (HMO) Medical Director:
- Served as the clinical lead for 150,000+ member plan
- Created an IPA in West Hawaii
- Led the pilot program that was integral to successfully implementing statewide Patient Centered Medical Homes
- Served as HMSA Credentialing Committee Chairperson
- Responsible for clinical oversight of disease management, and quality management of HMSA delegated disease management vendor, Healthways
- Served as HMSA Pharmacy Management Clinical Lead in 2009 and had oversight of clinical pharmacy team and quality improvement initiatives
- Chaired the Utilization Management Policy Committee, which reviewed and updated policies and developed new policies regarding medications, procedures, and therapies
Family Practitioner (1/2 time) and Associate Medical Director (1/2 time)
Kuhio Medical Center (HMSA subsidiary)
Lihue, Hawaii
07.1990 - 09.2005
- Responsible for reviewing, managing, and organizing the Clinical Practice Guidelines adopted by HMSA
- Coordinated various specialty physician advisory committees reviewing guidelines recommendations and collating into common source document
- Responsible for reviewing member complaints and grievances for all lines of business
- Responsible for developing and implementing credentialing, utilization management, disease management, and quality management strategies for all lines of business
- Family physician primary care and patient care responsibilities for 1500 patient panel
- Prior to July 2002, served as part-time Medical Director, starting in June 1994, with 80 percent of time dedicated to clinical duties as a family practitioner within the medical center’s multi-clinic model. From July 1990 to June 1994, served as family practitioner with a patient panel of approximately 2,000, including carrying out the duties of Certified Medical Examiner for disability evaluations and Medical Review Officer responsible to validate drug screening evaluations.
Education
Doctor of Osteopathic Medicine (D.O.) - undefined
College of Osteopathic Medicine of the Pacific
Master of Science - Public and Environmental Health
University of Hawaii at Manoa
Bachelor of Arts - Biology
University of Hawaii at Manoa
Skills
- Championed patient safety advocacy initiatives to elevate care standards Directed patient care strategies to optimize clinical outcomes Oversaw clinic administration with a focus on ethical practices and integrity Led healthcare management projects aimed at continuous quality improvement Developed patient relationship management protocols to enhance satisfaction Managed practice operations to streamline efficiency and effectiveness
Certification
- Board Certified – American Osteopathic Board of Family Physicians (Lifetime)
- Licensed Osteopathic Physician & Surgeon in Hawaii since 1986; license number DOS547
- American College of Osteopathic Family Practitioners – Certified since March 1987
Affiliations
- American Academy of Family Physicians member since 1984
- Hawaii Academy of Family Physicians member since 1990
- American Osteopathic Association member since 1980
- American College of Physicians’ Executives member since 1990
- American Academy of Disability Evaluating Physicians member from 1992 to 1999
Timeline
Regional Chief Medical Officer
Hawaii Health System Corporation Kauai Region
07.2020 - Current
Chief Medical Officer (Full Time)
UnitedHealthcare Community Plan
06.2012 - 06.2020
Medical Director, Quality Management (Full Time)
Blue Cross and Blue Shield Association
09.2005 - 06.2012
Family Practitioner (1/2 time) and Associate Medical Director (1/2 time)
Kuhio Medical Center (HMSA subsidiary)
07.1990 - 09.2005
Doctor of Osteopathic Medicine (D.O.) - undefined
College of Osteopathic Medicine of the Pacific
Master of Science - Public and Environmental Health
University of Hawaii at Manoa
Bachelor of Arts - Biology
University of Hawaii at Manoa