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Click here or scroll down to respond to this candidateErin Leigh OBrien MDStreet Address Pinellas Bayway South Unit HTierra Verde, FL Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEPROFESSIONAL SUMMARYDedicated, motivated and energetic obstetrician gynecologist with added certification in genetics and genomics that is highly skilled in utilization and case management. Excellent leadership skills with experience in complex clinical care coordination, quality improvement and credentialing. Exceptional at creating innovative approaches to enhance member and provider experience. Passionate about incorporating social determinants of health into collaborative physical and behavioral health improvement strategies. Partner with thought leaders in my market to implement statewide programs to improve maternal child health. CAREER EXPERIENCE AND CONTRIBUTIONSCentene Corporation Florida 2018- PresentMEDICAL DIRECTOR- Ambetter Marketplace - Medical Affairs Lead Marketplace/ Exchange/ Off Exchange Medical Director responsible for clinical and business oversight of the plan. Adjudicate health plan case reviews for Acute care, post-acute care, prior authorization, high cost/risk members, appeals, grievances, peer to peer, pharmacy and other assigned reviews related to utilization management. Oversaw the Maternal Child Health program Smart Start for Babies and acted as Subject Matter Expert for Obstetrics, Gynecology, Womens Health 2018-present Subject Matter Expert Added Certification in Genetics and Genomics by American College of Obstetrics and Gynecology Instituted an interdisciplinary Maternal Health Care program including OB rounds, OB Home Health collaborations with Optum, OB Mental Health programs with Brave Health and 180 Health Partners and ASAP and postpartum support programs with WIC and NICA. Incorporated physical health, behavioral health, case management, utilization management and medical affairs. Established a relationship with Florida Association of Nurse Midwives and American College of Nurse Midwifery to promote midwifery care to our members. Established communication with Commission on Accreditation of Birth Centers to increase the number of Accredited Birth Centers in our network. Established relationship with Spora Health to decrease racial disparities in African American populations. Oversaw the credentialing process improvement project for Certified Nurse Midwives, Licensed Midwives and Certified Professional Midwives and created an educational program for the credentials committee and medical director team on the various licensure and scope of each type of provider.Acting OB/GYN/Genetics Medical Director for Texas Market Jan-Feb 2022 Covered Superior Health Plan as specialty medical director. Learned UM for all lines of business and contractual nuances of state specific programs. Responsible for census management and discharge planning with concurrent review and post-acute teams. Encouraged interdisciplinary rounds with behavioral health, home health/ DME team, contracting team to facilitate discharge planning challenges and reduce length of stay. Oversaw the Ambetter rounds for Florida statewide, Obstetric rounds for all lines of business, and complex discharge planning rounds for all lines of business. Medical Director for Medicare Interdisciplinary Conferences for Medicare Advantage and Dual Enrolled members. Medical Director liaison with the Special Investigations Unit team. Work with Sunshine Health and Centene Corporate on Fraud Waste and Abuse projects. Medical Director liaison with the contracting department to facilitate special case agreements for challenging cases requiring out of state or complex care not available within the network.Central Florida Health Care, Inc. 05/2014-01/2018Physician and Department Head- Ob/Gyn Winter Haven, FL A Place for Women 03/2013 04/2014Physician - Ob/Gyn Celebration, FLHope Clinic Inc. 05/2011 02/2013Physician Ob/Gyn Houston, TXKelsey Seybold Clinic 02/2007 04/2011Physician Ob/Gyn Houston, TXPhysician Wetherby Locums Dr. N. Rao, FACOG 02/2007 02/2007 Physician Ob/Gyn Webster, TXBluebonnet Ob/Gyn 09/2003 12/2006Physician Ob/Gyn Bastrop,TX Womens Hospital of Texas 05/2003-05/2003Treatment Room Staff Physician Ob/Gyn Houston, TX Louis J. Brunoforte, PA 06/1995 01/1999Patent Agent Prosecuting patent applications/property matters Tampa, FLFlorida State University Dept. of Chemistry 01/1995 05/1995 Laboratory Instructor General ChemistryHillsborough Community College 09/1994 05/1995Instructor for Undergraduate Courses Tampa, FL (Human Reproduction, Environmental Science, & Nutrition and Disease)Education:Residency Obstetrics and Gynecology 11/2000 06/2003 Baylor College of Medicine Houston, TXObstetrics and Gynecology 06/1999 10/2000Medical University of South Carolina Charleston, SC Medical School Doctor of Medicine 08/1995 05/1999 University of South Florida Tampa, FL Undergraduate Bachelor of Science in Biological Science 08/1990 - 05/1994Florida State University Tallahassee, FLCertification:Diplomate American Board of Obstetrics and Gynecology 01/2006 currentFellow American Congress of Obstetrics and Gynecology 2006 current Junior Fellow, American College of Obstetrics and Gynecology 2003 2006United States Patent Bar Registration Number 42,948 Staff Privileges: Florida Hospital Celebration 2013 2014 Womens Hospital of Texas 2007 2011Bay Area Surgicare 2008 2011Clear Lake Regional Hospital 2008 2010St. Davids Surgicare of South Austin 2005 2006St. Davids South Austin Hospital 2004 2006Smithville Regional Hospital 2003 2006Fayette Memorial Hospital 2004 2005 Womens Hospital of Texas 2003 2003Committee/WorkgroupsMedical Director for Ambetter Provider Manual workgroup 2022- present Medical Director for Ambetter Explanation of Coverage workgroup 2021- presentMedical Director for Ambetter Post Acute Workgroup 2022-present Medical Director for Ambetter Readmission Workgroup 2019- present Member of Sunshine Health Credentials Committee and Peer Review Committee 2018-2020.Member of Sunshine Health Quality Innovation Committee 2020- present Chair of Sunshine Health Utilization Management Committee 2022- presentChair of Sunshine Health Clinical Policy Workgroup 2022- present Member of Sunshine Health Network Optimization Workgroup 2019-2021 Member of Sunshine Health Transportation Committee 2022- present Member of Centene Enterprise Wide Safety Workgroup 2022-present Member of Centene HPAC 2022-presentMember of Centene Payment Integrity Workgroup 2022-present Presenting Medical Director Doc Talk 2022Presenting Medical Director OB/GYN Clinical Policy Workgroup 2020- present |
