UPMC Health Plan
Two Chatham Center, Suite 1100
112 Washington Place
Pittsburgh,
PA
USA
15219
Email:
culybamj@upmc.edu
Biographical Sketch:
2001-2003; 2004-present, Vice President, Medical Affairs, UPMC Health Plan, Pittsburgh, Pennsylvania
Successfully redesigned Asthma and Diabetes Disease Management programs that resulted in significant improvement in clinical indicators and reduction in admissions and ED visits.
Developed and implemented Congestive Heart Failure program that successfully improved clinical outcomes and reduced inpatient readmissions.
2003–2004, Vice President, Medical Director, Heritage Valley Health System, Beaver, Pennsylvania
Successful development and implementation of a self-funded Home Host health insurance program for the Health System.
Successfully engaged the medical staff of the Beaver Campus to actively participate in clinical quality improvement projects including Congestive Heart Failure and Community Acquired Pneumonia.
2000-2001, Medical Director, Gateway Health Plan, Pittsburgh, Pennsylvania
Assisted in the development and implementation of their Disease Management Programs including Congestive Heart Failure, Diabetes, Asthma, and High Risk Pregnancy.
Lead a collaborative effort of all three Medicaid Health Plans in southwestern Pennsylvania to develop a universal Obstetrical Needs Assessment Form to improve the identification and clinical case management of pregnant Medical Assistance recipients.
1997-2000, Vice President/Medical Director, Heritage Valley Health System, Beaver, Pennsylvania
Developed a medical management program, incorporating existing case management, outcomes management, and credentialing resources, which is in full compliance with NCQA accreditation standards as well as Pennsylvania Department of Health and HCFA regulatory requirements.
Full delegation of medical management responsibilities from contracted managed care organizations followed by annual on-site reviews without major recommendations.