SANDRA GUERRA, MD, MPH
San Antonio,TX
Summary
Experienced Execuitve Physician leader in public health, population health management, healthcare expertise, and clinical quality. Background in large multidisciplinary health organizations, serving as a clinician, executive, and medical director. Successfully navigated dynamic demands and complex expectations from various stakeholders, including physician partners, advocacy groups, patients, governmental organizations, contractors, media, health insurance executives, and elected officials. Results-oriented and patient advocate, excelling at creative problem-solving and identifying process improvement needs to enhance healthcare quality. Dedicated focus on health equity, social determinants of health, and population health improvement. Successfully served diverse populations such as Medicare, Medicaid, military families, immigrants, and marginalized patients. Clinical leadership in outbreak control, disaster response, and improving access to high-quality healthcare nationwide. Skilled public speaker with broad audience appeal and clinical expertise. Proven ability to drive business growth through innovative clinical programs. Medical leader for accreditations and audits/reviews with powerful success measures. Well-versed in effective management techniques that enhance staff productivity and job satisfaction. Commitment to community involvement evident through role as a Board of Director member for non-profit organizations and dedication to mentoring women, minorities, and students.
Overview
22
22
years of professional experience
Work History
National Medical Director
Loyal Source Government Services, LLC
06.2023 - Current
- Physician Executive leader responsible for population health management /direct clinical services on the humanitarian Customs and Border Protection federal contract for migrant health services.
- Provided clinical supervision for over 800 staff located at over 90 facilities and ports of entry across the US-Mexico border of the United States.
- Led the health care system including clinical programs, clinical quality, policy interpretation and implementation, peer review process, incident reporting
- Interacted with federal government clinical leadership.
- Developed and maintained clinical Standard Operating Procedures for clinical services.
- Served as the executive clinical lead for RFP development.
- Supervised clinical staff, providing continuous professional development opportunities and training to maintain and strengthen competencies.
- Improved patient outcomes and delivery of care through improved clinical quality processes.
- Conducted ongoing evaluations of medical practices, ensuring adherence to evidence-based guidelines and best practices.
- Managed multidisciplinary teams, fostering collaboration between various healthcare professionals for optimal patient care.
CEO & Expert Consultant
Population Health Consulting
01.2023 - Current
- Founder of health care consulting company focusing on public health, health insurance, and population health.
- Provide expert consulting to health care systems, non-profit groups, attorneys and businesses in response to health-related situations such as outbreaks, exposures, contaminations, policy implementation, contract solicitations, determinations and legal actions.
- Evaluated client needs and expectations, establishing clear goals for each consulting engagement.
- Managed client relationships through regular check-ins and updates on project progress.
- Generated reports detailing findings and recommendations.
- Engaged in supporting client's proposals or positions during meetings, depositions, trials or presentations to stakeholders.
Chief Medical Officer
Texas Health Action
06.2022 - Current
- Physician leader of a non-profit clinical organization dedicated to health protection and health equity
- Telemedicine service oversight
- Board of Directors for Texas Health Action Physician organization
- Supervision of physicians and clinical quality of care teams
- Clinical oversight and provision of clinical duties/standing delegation orders/standard operating procedures for clinical care.
- Clinical quality oversight, response and quality improvement.
- Supervision and responsibility of Post Graduate Education residents and other clinical education programs.
- Emerging disease management, treatment, and prevention.
- Clinical media interactions and engagement with elected officials regarding health trends, policy impacts and other high profile health related situations.
Public Health Consultant
San Antonio Metropolitan Health District
01.2021 - Current
- Improved community health outcomes by implementing targeted public health programs.
- Tuberculosis clinical consultant to review medical records and provide clinical guidance/orders.
- Medical expert evaluation of fetal/newborn deaths by evaluation of clinical records, patient interviews, test results
- Fetal-Infant-Maternal Death Review-Chair Case Review Team
- Led the Community Action Team to improve birth outcomes.
- Serve as interim Local Health Authority when needed
Medical Director
Molina of Ohio
04.2023 - 10.2024
- Conducted ongoing evaluations of medical practices through a review of relevant medical records ensuring adherence to evidence-based guidelines and best practices.
- Improved patient outcomes and delivery of care through improved clinical quality processes.
- Performed Utilization Management Reviews of network providers health care services for Medicaid members for medical necessity and appropriate documentation.
- Offered peer to peer discussions on urgent or emergent cases.
- Evaluated continued stay reviews and level of care authorization reviews
- Engaged with nurses and Care Mangers to ensure members received needed services.
- Identified deviations in standards of care.
- Documented medical necessary determinations in health documentation system and provided language for member determination letters at the appropriate reading level.
- Provided ethical clinical lens for healthcare determinations, reconsiderations and appeals.
Chief Medical Officer
Centene/WellCare of Kentucy
01.2021 - 06.2022
- C-suite executive clinical leader in population health management for all Centene health products in Kentucky
- Responsible for health care policy impacting Kentucky Medicaid managed care membership of over 500K patient lives.
- Experienced significant membership growth in Medicare, Medicaid and ACA patient membership.
- Provided key leadership in support of network providers during COVID response in rural areas of Kentucky.
- Established an Ethics Review Committee
- Provided expertise in provider issue resolution, HEDIS/STARS attainment, process improvement, accreditations, audit oversight, innovative health solutions to improve performance and increase revenue.
- Responsible for Utilization Management, Appeals, Case Management, Quality Care with over 200 multi-disciplinary staff.
- Organizational transformation experience including process evaluation and process improvement.
- Success metrics: reduction in readmission rate, reduction in length of stay, increased HEDIS scores, increased COVID vaccination rate
- Improved patient care by implementing evidence-based clinical practices and protocols.
- Collaborated with executive leadership on strategic planning initiatives to align organizational goals with industry trends and best practices.
- Led the development of a multidisciplinary team to enhance collaboration and quality healthcare delivery.
Interim Health Director
San Antonio Metropolitan Health District
07.2020 - 12.2020
- Stepped in to provide public health leadership during the peak of the COVID Pandemic (pre-vaccine) to provide leadership to a team of over 450 full time staff and 300 part time staff.
- Duties included oversight of all public health programs, emergency remote work assignment, collaboration with City Council and City Manger, daily public briefings with City Mayor and County Judge on COVID status, analytics, coordination with emergency response and disaster responders, establishment of mass vaccination primary care clinical evaluations, administration of immunizations to high-risk populations, responding to critical clinical situations, evaluation of patients with symptoms consistent with COVID infection.
- Maintained oversight, training and supervision of residents, medical students, nurses in training and other post graduate students.
- Clinical leader for governmental agency in 6th largest city in the United States. Supervised the Local Health Authority of Bexar County.
- Expertise in disease containment in congregate settings (nursing homes, LTAC’s, correctional facilities, educational institutions) including patient evaluation.
- Clinical process improvement, planning, quality oversight
- Managed budgets and financial resources responsibly, resulting in consistent cost savings while maintaining high levels of care quality.
- Enhanced community health through strategic partnerships with local organizations and stakeholders.
- Evaluated the efficacy of existing health interventions, making data-driven adjustments as needed to ensure maximum impact on community wellbeing.
- Reduced instances of communicable diseases within the community through proactive prevention efforts and education campaigns.
Vice President, Chief Medical Officer
Humana Government Business
10.2012 - 02.2020
- Executive physician responsible for the largest military health contract in the US (TRICARE)- 6 million lives as a Preventive Medicine/ Population health expert.
- Oversight of over 350,000 health providers in network, including peer to peer interactions and population health improvements.
- Policy implementation and interpreted clinical guidance
- Ensured high quality health care system access including referral/authorization, denials, appeals, medical necessity evaluations, targeted predictive analytics, customer service and steerage models.
- Operational excellence in over 150 performance metrics and ascertainment of unprecedented performance incentives.
- Responsible for federal government relations.
- Expert leader in Utilization Management, Provider Credentialing and Network Management, Peer Safety Peer Review, Quality Management and Process Improvement, Prevention Services (HEDIS/STARS) and URAC accreditations/audits.
- Supervised a multidisciplinary clinical team of 1000 associates including executives, directors, physicians, and clinicians. I directly supervised 13 executives and clinicians, in a remote work environment.
- Cultivated strong relationships with key stakeholders, including customers, vendors, regulators, and community leaders to promote collaboration and long-term success.
- Led cross-functional teams for the successful completion of major projects, resulting in increased efficiency and client satisfaction.
- Demonstrated proficient leadership skills to motivate employees and build competent teams.
- Collaborated with senior management to develop strategic initiatives and long term goals.
Regional Medical Director/Residency Director
Texas Department of State Health Services
10.2005 - 10.2012
- Responsible for the provision of essential public health services in 28 counties in south central Texas-population of 2.8 million persons.
- Local Health Authority for the region.
- Clinical responsibilities included patient care in tuberculosis, STI, family planning, immunization, vaccine preventable illnesses, communicable disease evaluations and quarantine, and primary care in disaster response including shelters, detention facilities, and other locations.
- Responsible for an annual budget of $10.5 million.
- Health Care Facility oversight, licensure
- H1N1 Pandemic Response
- ACGME accredited Preventive Medicine Residency Program Director- responsible for the training post-graduate experiences for medical residents seeking The American Board of Preventive Medicine certification in Public Health and General Preventive Medicine.
Assistant Clinical Professor
University of Texas Health Science Center
01.2006 - 01.2008
- Direct primary medical care services as a Family Physician in San Antonio through University of Texas Health Science Center- San Antonio Express Med Clinic (Urgent and correctional facility care)
Assistant Medical Director
San Antonio Metropolitan Health District
01.2003 - 01.2006
- Executive management physician responsible for public health infrastructure
- Clinical supervisor and provider for all public health clinics including STI, TB, communicable disease, disaster response, dental, family planning, well child, and dental services.
- Supervised approximately 75 staff including clinical operations for 12 sites across San Antonio.
- Disaster response Incident Commander
Education
Masters of Public Health - Public Health
University of Texas Health Science Center
Houston, TX12-2002
M.D. -
Texas A&M Health Science Center
College Station, TX06-1998
Bachelor of Science - Child Development & Family Relationships
University of Texas At Austin
Austin, TX05-1993
Skills
- Chief Physician with Executive Experience
- Population Health Management Expert
- Complex Health System Navigation
- Government Expertise
- Non-Profit Governance
- Stakeholder Communication
- Outbreak Response Consultant
- Business Development Skills
- Community Engagement
- Process Improvement in Clinical Quality
- Community Health Consulting
- HEDIS Performance Improvement
- Utilization Management Skills
- Credentialing Compliance Oversight
- Professional Accreditation
- Skilled Public Spokesperson
- Socioeconomic Health Influences
- Performance Measurement Skills
- Professional Testimony Services
- Collaborative Clinical Leadership for Government Agencies
- Standard Operating Procedures Development
- Leadership in Clinical RFP Strategy
Timeline
National Medical Director
Loyal Source Government Services, LLC
06.2023 - Current
Medical Director
Molina of Ohio
04.2023 - 10.2024
CEO & Expert Consultant
Population Health Consulting
01.2023 - Current
Chief Medical Officer
Texas Health Action
06.2022 - Current
Public Health Consultant
San Antonio Metropolitan Health District
01.2021 - Current
Chief Medical Officer
Centene/WellCare of Kentucy
01.2021 - 06.2022
Interim Health Director
San Antonio Metropolitan Health District
07.2020 - 12.2020
Vice President, Chief Medical Officer
Humana Government Business
10.2012 - 02.2020
Assistant Clinical Professor
University of Texas Health Science Center
01.2006 - 01.2008
Regional Medical Director/Residency Director
Texas Department of State Health Services
10.2005 - 10.2012
Assistant Medical Director
San Antonio Metropolitan Health District
01.2003 - 01.2006
Masters of Public Health - Public Health
University of Texas Health Science Center
M.D. -
Texas A&M Health Science Center
Bachelor of Science - Child Development & Family Relationships
University of Texas At Austin
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