Julie Arotin, MS, RN, CCP

Clinical Trainer, Milliman Care Guidelines

Julie has 20 years of nursing experience in a diverse variety of clinical settings including inpatient, long term care, private practice, military medicine and utilization review holding both clinical and management positions.

Prior to coming to Milliman Care Guidelines, she worked for a company where she utilized clinical knowledge and expertise to provide consultative services and client education for clinical software applications. Additionally, she assisted clients in developing policies and procedures related to clinical software applications including case management, risk management, quality/performance improvement and infection control.

Tauheedah Avinger, RN, BSN

Senior Product Manager, Milliman Care Guidelines

Tauheedah has over 25 years of experience in the healthcare industry. Her nursing background includes cardiovascular ICU nursing and utilization, case and disease management. For the past 10 years, she has been a business leader in the area of healthcare IT software development and implementation. She manages the business requirements for medical management systems and clinical applications. As the CareWebQI expert and resource, Ms Avinger is responsible for the overall development of new features and functionality that meet the business needs of the client. She works closely with IT Development and QA Analysts teams throughout the development cycles and release process.

Karen Ball, RN, BA, BEd, MA

Team Leader - Travel Assistance, Active Care Management

In the 20+ years since receiving her nursing diploma, Karen has gained extensive experience at both the Hospital for Sick Children in Toronto and the Children’s Hospital of Western Ontario in the PICU. She also has applied her Masters in Sociology in Education while teaching nursing to many students. She has built on previous experiences to lead the Travel Assistance Clinical team in performing industry leading support and customer service for clients around the world.

Gary Barnett

Web Operations Lead, Milliman Care Guidelines

Gary has 20 years of IT and IT operations experience in the health care and legal fields.

He manages the deployment and maintenance of our products that are delivered via the Internet and has developed several of our content delivery products.

Gary has been with Milliman Care Guidelines for 5 years.

Lisa Beichl

International Health Specialist, Milliman Care Guidelines

Lisa is a specialist in international health insurance (public and private) and related medical delivery issues. Her concentration in non-US markets began in Germany with United Healthcare where she consulted on metrics development with a large German public health fund developing a disease management program, and later worked on improving metrics with a third party administrator operating in the Middle East. Later, she held leadership positions in Switzerland with Swiss Re Life and Health, and in Germany with Allianz and Munich Re, focused on health insurance/reinsurance strategy and operational development in Latin America, Central and Eastern Europe, the Middle East and Southeast Asia. As an independent consultant, she worked on international strategic development projects, as well as working as a consultant on behalf of USAID (PSP-1) in Nigeria.

Leah F. Binder, MA, MGA

Chief Executive Officer, The Leapfrog Group

Leah Binder is CEO of The Leapfrog Group, a national organization based in Washington, DC, representing employer purchasers of healthcare demanding improvements in the safety of the nation’s hospitals. Before joining Leapfrog in the spring of 2008, Ms. Binder spent 8 years as vice president at an award-winning rural hospital network in Farmington, Maine, Franklin Community Health Network, and before that she was a senior policy advisor for the Office of Mayor Rudolph Giuliani in New York City. She started her career at the National League for Nursing, where she handled policy and communications for over 6 years. She has a BA from Brandeis, and two masters from the University of Pennsylvania, one from the Annenberg School of Communication and the other from the Fels Institute of Government.

Helen Blumen, MD, MBA

Managing Editor, Milliman Care Guidelines

Helen has worked with Milliman Care Guidelines since 2003, and is responsible for clinical content for case and disease management, prior authorization, and new technology assessment guidelines.

Helen has worked in the area of care guideline development and implementation for more than 15 years. She has extensive experience in embedding clinical guidelines into software products, including expert systems. She has developed and implemented utilization management, case management, disease management, and quality improvement programs for Medicare, Medicaid, and commercial managed care operations.

Prior to her career in managed health care, Dr. Blumen practiced general internal medicine for over 10 years. She received her MD degree from UCLA and her MBA from the Johns Hopkins University. She is Board-certified in Internal Medicine and a Fellow of the American College of Physicians.

Louise Bower, BS, RN

Product Consultant, Milliman Care Guidelines

Louise joined the firm in 2004. In this position, she assists current and potential customers in learning more about ways in which the guidelines and interactive applications can assist in achieving organizational goals.

In addition to her clinical nursing experience, Ms. Bower has over 17 years of Medical Management experience in leadership positions where she developed and implemented patient care management systems. Her consulting experience extends internationally.

Jane Brock, MD, MSPH

Chief Medical Officer, Colorado Foundation for Medical Care

Jane Brock, MD, MSPH, currently serves as the Chief Medical Officer of the Care Transitions Theme Quality Improvement Organization Support Center located at the Colorado Foundation for Medical Care. The Care Transitions Theme includes 14 Quality Improvement Organizations working with local communities of providers to create and support care coordination to reduce unnecessary 30-day re-hospitalizations. She spent 18 years in primary care practice at the Boulder Medical Center, and continues to provide occupational medical services in a Lexmark printer manufacturing facility. Brock received her M.D. from the University of Kansas, her MSPH and Preventive Medicine training from the University of Colorado, and a bronze-level Lean Certification from the Society of Manufacturing Engineers. Her work focuses in three main areas: applying principles of occupational medicine to physician work in outpatient settings, developing cross-setting standard operating procedures to implement coordination of care best practices, and using quality improvement techniques to reduce harmful over utilization of medical services.

Shannon Brownlee

Author of Overtreated; Schwartz Senior Fellow; New America Foundation

In her landmark book Overtreated, Shannon Brownlee conducts an unblinking examination of our ailing health care system—the invisible shaper of all our lives. One of America's foremost experts on health care policy and reform, Brownlee is a voice of clarity and intelligence who offers provocative solutions—and real hope—on how to fix what she refers to as our "dysfunctional, unfair and spectacularly expensive system."

Shannon Brownlee's Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer was named the best economics book of 2007 by The New York Times. In it, she shows us that much of what we know about health care—one of the most politically, socially and economically contentious issues today—is simply wrong. Every year America's medical system wastes a staggering amount on costly, unnecessary treatments that do little to improve our health, and which may actually be dangerous. She looks at how well-insured Americans get more high-tech treatment than they need, enriching the doctors, hospitals and medical companies who provide it, but driving up the costs of health care for everyone else.

With Overtreated, Brownlee addresses these issues, as well as others ailing the health care sector, offering incisive answers and a way forward. Dr. Jerome Groopman (How Doctors Think) writes, "Patients, physicians, and policy makers would do well to consider her evidence as an important prescription for reform."

An acclaimed journalist, Shannon Brownlee has written for The Atlantic Monthly, Slate and TIME. She is the recipient of The National Association of Science Writers Science-in-Society Award and the Association of Health Care Journalist's Award for Excellence. As a Schwartz Senior Fellow at the New America Foundation, a non-partisan think tank, she gives talks to the general public and government agencies on health care policy and the pharmaceutical industry. She has taught writing programs at University of Maryland and UC Santa Cruz, and has lectured at universities, including the NYU School of Journalism, and at conferences, including The Nobel Laureates symposium.

Dorothy Correa, RN, FNP, MSN

Managing Editor, Milliman Care Guidelines

Dorothy has been a Care Guidelines writer, reviewer and Editor since 2000, starting with work on the company’s Care Companion. Before that, Dorothy was a Family Nurse Practitioner at U.C. Davis Medical Group, and at Sutter Memorial Hospital. She also was a clinical consultant for Access Health.

Dorothy is a Registered Nurse and a Family Nurse Practitioner. She received a BA in Psychology from the University of Colorado, an ADN in Nursing from Sacramento City College, and BSN and MSN from University of California, San Francisco.

Jamie Dunham, MS, BSN

Business Unit Manager, ThedaCare, Inc.

Jamie Dunham, RN, BSN, MS is a Business Unit Manager at Appleton Medical Center in Appleton, Wisconsin, part of the ThedaCare System. Jamie earned bother her undergrad and graduate degrees from Marian College in Fond du Lac, WI. She has been with the ThedaCare System her entire career and has held various positions that have included Staff Nurse, Community Health Educator, Staff Development Educator, Project Coordinator and Business Unit Care Manager on an array of different specialty units. Jamie was part of the design team for the Collaborative Care Unit and continues to be responsible for the overall management and strategic leadership for that unit.

Elysa Ferrara, BS, MPA, ABD

National Director of Provider Quality and Performance Initiatives, Aetna

Elysa Ferrara is Aetna's National Director of Provider Quality and Performance Initiatives where she is responsible for the development and implementation of Aetna’s provider quality initiatives for physician, hospital and health provider incentive programs and collaborations, provider payment reform and Aetna’s Institutes of Excellence and Institutes of Quality designation initiatives. Elysa’s group is also responsible for development and implementation of related Aetna policies, most recently developing Aetna’s serious adverse hospital event policies. Elysa serves as Aetna’s liaison to the Leapfrog Group, Bridges to Excellence and for the National Business Coalition’s EValue8 Survey. Prior to this position, Elysa was Market Head for the New York State market with Aetna and responsible for the Northeast Region performance incentive/ pay for performance programs for hospitals and physicians managing a team of 11 staff. Elysa joined Aetna in 1996. Prior to joining Aetna, Elysa was with the NYS Department of Health as Director of the Commissioner’s Quality Office, a deregulation and performance measurement and quality partnership with medical, business and hospital leadership. As Director of the State's Health Policy Bureau, Elysa oversaw the NYS health planning, rural health, and numerous policy initiatives. Elysa is currently a member of the Board of Directors of the Upstate Chapter of the National Multiple Sclerosis Society.

Garrett Foulke, MD, MMM, FACP, FCCM, FACPE

Senior Editor, Milliman Care Guidelines

Before joining Milliman Care Guidelines in 1999, Garrett was on the full time faculty of the University of California, Davis School of Medicine for more than 14 years. He was a professor there and continues to hold a teaching appointment as Clinical Professor of Medicine in the Division of Pulmonary/Critical Medicine. He was also the Medical Director of Clinical Resource Management and Managed Care for the University’s Health System.

Garrett is a Medical Doctor, Master of Medical Management, and is a Fellow of the American College of Physicians, American College of Critical Care Medicine, and the American College of Physician Executives.

A graduate of the University of California, Berkeley and the University of California, Los Angeles School of Medicine, Garrett completed an internship and postgraduate training at the University of California Davis Medical Center. He is board certified in Internal Medicine, Pulmonary Diseases, and Critical Care Medicine. His Masters in Medical Management is from Tulane University.

Jeff Frater, RN, BSN, CCM

Clinical Trainer, Milliman Care Guidelines

Jeff has over 10 years experience in a variety of healthcare settings, which includes a combination of clinical nursing and case management positions. Prior to joining Milliman Care Guidelines, Jeff held positions in primary care, acute hospital, and post-acute inpatient and managed care settings.

Jeff has developed and presented education for case managers on clinical topics such as diabetes, renal failure, anemia and neutropenia; and has developed and presented case management content such as observation care strategies and primary care case management. Jeff has also written and presented health care reimbursement education for clinical staff (physicians, nurses, pharmacists, and physical therapists). Jeff is active in the Case Management Society of America. Previously he was on the National Board of Directors for CMSA and is currently the President.

Rajesh Godavarthi, CSM, MCP

Director of Technical Support & Project Management, Milliman Care Guidelines

Rajesh has a Masters in Computer Science and Project Management certification from University of Washington. He has ten years of experience including leadership and management roles in software development.

Prior to joining Milliman Care Guidelines, Rajesh worked with Intel, Citigroup, and MCI developing enterprise software products for web, desktop and reporting solutions. He excels at leading software group of software developers and has extensive knowledge of software development processes including waterfall (SDLC) and iterative (SCRUM) development processes. Additionally, Rajesh has a working knowledge of the healthcare industry and standards including HIPAA and HL7.

Alan Greenfield, MD, MBA

Editor, Milliman Care Guidelines

Before joining Milliman Care Guidelines in 2007, Alan worked for 20 years in the healthcare industry, holding positions including VP/Chief Medical Officer for Cost Care, Senior VP/Chief Medical Officer for Foundation Health, VP Medical Affairs for Health Net, Regional Medical Director for PacifiCare, and Senior VP/Chief Medical Officer for Lakeside Healthcare. A graduate of University of Pennsylvania School of Medicine, Alan completed his General Surgery residency training at the Pennsylvania Hospital in Philadelphia. In addition, he holds a Masters in Business Administration from Pepperdine University School of Business and Management.

Shana Herzfeldt, RN, BSN

Operations Supervisor - Collaborative Care Unit, ThedaCare, Inc.

Shana Herzfeldt, RN, BSN, is a Supervisor of Medical Services at Appleton Medical Center in Appleton, WI. Shana earned her nursing degree from Eau Claire University in Eau Claire, WI. Her past positions include Staff Nurse and Clinical Team Leader. Shana is responsible for day-to-day operations of a fourteen bed research and development unit titled “Collaborative Care”. The role’s emphasis is to identify opportunities for improvement within the health care system using LEAN concepts and to develop/teach individual staff members to see waste and actively problem solve. Recently, Shana has been involved in helping to design a new eight-floor bed tower-private room renovation project, with a focus on learning from the current unit she supervises.

Connie Hill, RN, BS, CPHQ, CPUR

Manager of Strategic Accounts, Milliman Care Guidelines

Connie helps clients to maximize the use of licensed Milliman Care Guidelines products to best attain their business goals. Before joining Milliman Care Guidelines in 2006, Connie held various level positions in consulting, quality improvement, account and medical management positions with MEDai, Orlando, Florida; Boon-Chapman, MMC Group, McKesson Health Solutions , Seton Network, Strategic Healthcare Initiatives, FirstCare, and Austin Diagnostic Clinic, all of Austin, Texas.

She is a graduate of Kennedy-Western University, Cheyenne, Wyoming; and Austin Community College, Austin, Texas.

Debbie Jepson, RN, CCP

Clinical Trainer, Instructional Design, Milliman Care Guidelines

Debbie's curriculum development skills focus on consistently meeting the needs of clinical adult learners. The focus of Debbie’s role has been to support the development of the Care Guidelines On Demand Training material.

Carol Johnson, RN, CCM, RN-BC, CCP, CTT+

Manager, Clinical Trainer, Milliman Care Guidelines

Carol has more than 25 years of experience in inpatient medical surgical nursing and management in clinical settings, including as a medical practice manager for multi-physician specialists. As business administrator for home health and hospice, she had direct oversight of pre-certification, case management and contract negotiations. She is a Certified Case Manager with extensive managed care and health plan leadership experience, including inpatient and ambulatory case-management programs, disease management, catastrophic case management, and specialty case-management programs including high-risk maternity, transplant, NNICU and oncology. Her managed care career experience includes work as case manager specialist, telephonic and onsite review nurse, prior authorization, clinical trainer, and national clinical project manager. As a Certified Technical Trainer, Carol has trained clinical and non-clinical staff, including physician medical directors.

Maju Kuruvilla

Vice President, Information Technology, Milliman Care Guidelines

Prior to joining Milliman Care Guidelines, Maju worked in software development and programming positions for Microsoft, Honeywell India and the Indian Institute of Science. Maju has significant experience in architecting, designing and developing leading-edge enterprise business solutions with a variety of development tools, technologies and platforms.

Mindy Lazor, RN, BSN, CCM, RN-BC, CCP

Clinical Trainer, Milliman Care Guidelines

Mindy has more than 30 years of clinical nursing and leadership experience in a variety of healthcare settings. She has worked in all areas of acute care nursing practice, and has extensive experience in both case, disease and utilization management. She has managed staff and developed training materials for managed care and disease management employers. Some of her other responsibilities also included oversight of pre-certification, medical necessity, outpatient treatment, technology, and utilization reviews for commercial, indemnity, and self-insured plans. Mindy has developed, trained and managed a national post-discharge services department. Mindy holds Case Manager Certifications from both the American Nurses Credentialing Center and the Commission for Case Management Certification. She received her Chronic Care Professional certification this year.

Tiffanie Lenderman, MBA, MSHA

Director - Government Relations, Milliman Care Guidelines

Tiffanie previously worked with Milliman Care Guidelines’s largest clients as an account manager. Her healthcare background includes working with provider networks, payor relations and public health organizations. She holds an MBA and MSHA from the University of Colorado Denver.

Mark Leveaux, MD

Staff Psychiatrist, Kaiser Permanente Northwest

Dr. Mark F. Leveaux has over 20 years’ clinical and administrative experience in staff and network HMO’s, as well as in accreditation, regulatory oversight, and consultative roles in behavioral health. His most recent current and past roles have been with Group Health Cooperative of Washington, Kaiser Permanente Northwest, The National Committee for Quality Assurance, and Managed Health Care Unlimited, a contractor for the California Department of Managed Care.

Donna McNamara, BSN, RN, PMP

Product Manager, Milliman Care Guidelines

Donna joined Milliman Care Guidelines in 2008. She is the Product Manager for the Interrater Reliability Tool and Learning Management System. She is a registered nurse with experience in various clinical fields, nursing education, managed care and clinical software and tools development and implementation.

Mark Michelman, MD, MBA

Medical Director of Quality Management, Case Management, Utilization Management & Physician Coding Advisor, Morton Plant Mease Healthcare

Dr. Michelman is Board Certified in Internal Medicine, Hematology, Quality Assurance and Utilization Review. He is Medical Director of Quality Management, Case Management, Utilization Management, and Physician Coding Advisor, all at Morton Plant Mease Health Care System, in Clearwater, Florida. He has served on the task force with the Florida Hospital Association and the Florida Agency for Health Care in the development, implementation, and education of the new CMS Present on Admission Indicator and the related Hospital Acquired Conditions. He frequently lectures at the local, state, and national level on MSDRGs, the Present on Admission Indicator, the Hospital Acquired Conditions, and other coding, documentation and case management topics.

David Mirkin, MD

Principal and Healthcare Consultant, Milliman, Inc.

David has provided consulting support and the Hospital Inpatient Profiler to Horizon BCBS and WellPoint East for several years.

Penny S. Moore, CMCE, RPh

Senior Vice President, SHPS, SHPS, Inc.

As senior vice president, SHPS healthcare solutions, Ms. Moore is responsible for leveraging SHPS’s ability to design and build healthcare management services that meet the current and evolving needs of its channel partners, including state Medicaid programs, health plans, and third-party administrators. Ms. Moore, who has more than 25 years experience in executive healthcare management and cost containment, is accountable for achieving growth and corporate objectives for three distinct business lines: Medicaid care management, carrier care management and hospital bill audit services.

Prior to her current position, Ms. Moore served as vice president, care management solutions with Landacorp, a SHPS company. She was responsible for launching population-based disease management solutions to third party administrators and selling health and productivity solutions directly to employers, brokers, consultants and carriers through a team of account executives.

Ms. Moore previously served at UnitedHealthcare, driving the development and executive direction of Medicare and Medicaid managed care contracts. She also served as area vice president, account development for CorSolutions, and has held executive positions with Aetna and Critical Care America.

Ms. Moore has a Bachelor of Science, pharmacy, with distinction and honors from the University of Missouri-Kansas City. She is a Certified Managed Care Executive (CMCE) from America's Health Insurance Plans.

Kim Motter, RN, BSN, CCM

Clinical Quality Manager, HHS Health Options

Kim Motter has over 16 years of experience working with the geriatric population and managed care industry. She has specialized in workflow development, process improvement, technology integration and regulatory compliance. Her experience includes multiple positions as a Registered Nurse providing services to the geriatric population including utilization management, case management and disease management activities. She has also held positions in continuous quality improvement and clinical management positions at HHS, Health Options. She is currently the Director of Technology Integration and Program Development for HHS, Health Options.

Lynn Nemiccolo, RN

Director of Business Product Development, Milliman Care Guidelines

Lynn's responsibilities include oversight of the software delivery products for the Milliman Care Guidelines, as well as strategic vendor relationships.

Prior to joining Milliman Care Guidelines, Lynn was the Director of Clinical Applications at a hospital overseeing their selection and implementation of a full EMR system. She has spent the last 13 years focused on providing software tools to clinicians in the area of workflow and clinical decision making. She has been a Director of Product Management for products supporting managed care workflow as well as working as a certified case manager. Her clinical background was in critical care nursing.

John Ninomiya, PhD, MSc, FSA, MAAA

Director, Epidemiology and Health Services Research, Milliman Care Guidelines

John is Director of Epidemiology and Health Services Research for Milliman Care Guidelines, based in the San Diego office. He is responsible for data analysis in support of clinical guideline development and healthcare utilization modeling. He joined the firm in 1998.

Prior to joining Milliman, John worked for 10 years at a well-known, publicly traded managed care company, the last five as corporate vice president for health data analysis. John was responsible for actuarial services, as well as data analysis in support of utilization management, quality assurance, and provider contracting. His projects included implementation of HEDIS® reporting and sponsorship of the data warehouse project. He was also involved in strategic planning for the health services area.

Ann O'Neill, RNC, MBA/HCM

Product Development Manager - Electronic Health Records, Milliman Care Guidelines

Ann is a Registered Nurse and holds a Masters in Business Administration and Healthcare Management. She has three decades of nursing experience in direct patient care and hospital administration. She has participated in the selection, implementation, and development of IT solutions for the bedside care of patients. Ann is the past Chief Nursing Officer for an electronic medical record system vendor. She is currently the Milliman Care Guidelines EHR Product Manager, looking at electronic options for the bedside toward improving patient outcomes.

Kathleen Passanisi, PT, CSP, CPAE Speaker Hall of Fame

Kathleen Passanisi, PT, CSP, CPAE Speaker Hall of Fame, and recipient of a Lifetime Achievement award in the field of therapeutic humor has helped thousands change their outlooks and their lives through her enlightening and entertaining programs. An internationally recognized speaker, humorist, medical professional, and author, Kathy brings substance, style, and clean hilarity to her universal content, guaranteeing a successful meeting with lasting effects.

Kathy founded New Perspectives in 1987 to address issues in wellness, quality living, stress management, and the link that exists between humor and health. Kathy is a past-president of the American Association for Therapeutic Humor and served on the adjunct faculty of the Washington University School of Medicine. Her clients range from the Fortune 500 to trauma teams, from cancer patients to married couples. Her work has been featured in the New York Times, US News and World Report, Working Woman, and England’s Sunday Business.

Kathy is the author of It’s Your Life – Choose Well and contributing author of Humor Me. Self-proclaimed poster woman for the sandwich generation, she is the funniest woman in Lake Saint Louis, Missouri and possibly the Western Hemisphere.

Jim Schibanoff, MD

Editor-in-Chief, Milliman Care Guidelines

Dr. Schibanoff is Editor-in-Chief for Milliman Care Guidelines. His principal role is guideline development and documentation. He is also co-author of the Inpatient and Surgical Care, Home Care, and Recovery Facility Care products.

His primary responsibilities include supervision of the editorial and peer review process of the Milliman Care Guidelines, analysis of the Care Guidelines evidence base, appointment and coordination of expert clinician panels, planning new guidelines and revision to existing guidelines. He also represents the Milliman Care Guidelines to consumer/patient groups, regulatory bodies and medical specialty societies and responds to clinical inquiries about the Care Guidelines from users. Dr. Schibanoff is board-certified in Internal Medicine and Pulmonary Medicine. He served as Chief Medical Officer of a San Diego healthcare system and led the implementation of total quality management as the most enduring method to simultaneously lower costs and improve quality. Dr. Schibanoff served for three years as Chief Executive Officer of two San Diego hospitals with a combined budget of $250 million. He was instrumental in system integration and in promoting physician participation in hospital governance.

Dr. Schibanoff graduated from Princeton University and the University of Southern California School of Medicine. His postgraduate training was at the University of California, San Diego, including Chief Medical Residency and Fellowship in Pulmonary Diseases.

John Semmens, MD

Healthcare Management Consultant, Milliman Inc.

John Semmens is a board certified internist with over 35 years of experience in various aspects of both private practice and managed care. He has been a healthcare management consultant at Milliman for 12 years. He practiced internal medicine in Phoenix, Arizona, from 1972 to 1997 and was a founder of a primary-care-based multi-specialty group that grew to a 50-physician practice. John was also co-founder of an HMO that was acquired by MetLife and subsequently United Healthcare of Arizona.

John has held appointments as an assistant Professor of Medicine at the University of Minnesota School of Medicine and Clinical Instructor of Medicine at the University of Arizona School of Medicine. Special interests include efficient management of clinical resources, development of disease management programs, evidence-based guideline implementation, and physician change management in the U.S. and internationally. He has extensive experience in evaluating the efficiency of healthcare delivery at the hospital and physician provider level. Evaluation of healthcare delivery includes extensive experience doing clinical chart reviews to evaluate the efficiency, resource use, quality and appropriateness of care in the inpatient and outpatient setting. At the health plan level, he has extensive experience in assessing medical management, making recommendations for change and assisting in the implementation of those changes. Other interests and experience include the development and support of individual and small group medical underwriting guidelines.

Sandy Silberman, RN, CCM, CCP

Clinical Trainer, Milliman Care Guidelines

Sandy has over 20 years experience in a variety of healthcare settings, which includes a combination of clinical and management positions. Prior to joining Milliman Care Guidelines, Sandy held leadership and clinical positions in the acute short- and long-term care setting, disease management field, and in managed care organizations. Sandy has developed and led case management programs in the insurance industry and the long-term acute care setting. She has been responsible for developing patient education, including curricula and educational materials development. In addition to developing and implementing educational programs for patients and health care professionals, Sandy has directed the activities of health plans and hospital services in preparation for external accreditation by both Joint Commission and NCQA.

Paul D. Smith, MD

Associate Professor of Family Medicine, University of Wisconsin

Paul D. Smith, MD is an Associate Professor in the University of Wisconsin Department of Family Medicine. He graduated with his BA in chemistry from DePauw University in Greencastle, Indiana in 1979 and received his MD degree from Wright State University School of Medicine in Dayton, Ohio in 1982. He completed his residency training at Maine-Dartmouth Family Practice Residency in August, Maine, in 1985. After residency, he joined the Family Practice Department at Health Services Association, a staff model HMO, near Syracuse, New York where he practiced for almost ten years. Dr. Smith then joined the University of Wisconsin Department of Family Medicine faculty in October 1995. Dr. Smith was appointed the Director of the Wisconsin Research and Education Network (WREN) in July 2006 and now spends most of his time with a variety of service and research activities in addition to practicing family medicine one day per week. He presently serves as a volunteer on the Board of Directors for Wisconsin Literacy, a statewide organization that coordinates activities for 57 community-based literacy organizations. He recently received the Wisconsin Literacy Advocate of the Year award. He is currently working on a project to train adult literacy students as consultants to a hospital to help improve the health literacy environment of the hospital and a second project to develop health literacy training curriculum for nursing students at a Wisconsin Technical College and practicing nurses at a local hospital.

LaShonda Swoope, RN

Utilization Management Trainer/Coordinator, BCBS of Tennessee

LaShonda Swoope has been with BCBST for five years. She currently works in the Commercial Training Department as the lead Training Coordinator. During the implementation of the Care Guidelines, her primary responsibilities include testing the guidelines, implementing the guidelines into the systems, training the end users whenever new editions are implemented or updates are received and maintaining the necessary training tools for the end users.

Opal Thomas, RN, MSN

Care Manager, St. Jude Medical Center

Opal Thomas has over 20 years of nursing experience in both clinical and administrative settings. She has received a MSN from Columbia University in New York.

She joined St. Jude Medical Center almost two years ago and has worked with Milliman to implement the Care Guidelines in the care management process.

Melissa Vaughn

Medical Policy Specialist, BCBS of Tennessee

Melissa Vaughn has been with BCBST for 25 years. Her primary responsibilities include providing technical support regarding various systems and software applications, maintains and updates BlueCross BlueShield of Tennessee Web sites, and provides project management support including the BlueCross BlueShield of Tennessee Modified Milliman Care Guidelines^® project.

Kathleen Vinson, RN, BSN

Program Manager of Clinical Resources, BCBS of Tennessee

Kathleen Vinson has been with BCBST for 12 years. Her primary responsibilities include the BCBST Modified Milliman Care Guidelines^® process. This process involves research and development of the Modified Milliman Care Guidelines^®, the annual review and approval process, and implementation of the guidelines. Kathleen also developed and coordinates the Medical Policy and Modified Milliman Care Guidelines^® Provider Appeals Process. Kathleen serves as the Milliman liaison for BCBST, coordinating continuing Milliman education. Kathleen graduated with a Bachelor of Science in Nursing from the University of Tennessee at Chattanooga.

Kevin Wagner

Lead Software Engineer - CareWebQI, Milliman Care Guidelines

Kevin has worked on CareWebQI, CareGuideQI and other interactive products during his three years with Milliman Care Guidelines. His background as a database architect includes time with Medicare Supplemental Insurers, Self Funded Plan Administrators and the telecommunications industry.

Anthony Watts, BS

System Analyst, BCBS of Tennessee

Anthony Watts has worked with BCBST for 10 years. His primary role is application and software support for the various Provider and Utilization Management systems. His responsibilities include software implementations, upgrades and maintenance. He currently serves as the Information Systems project lead for Care Guidelines implementations, upgrades and updates. Anthony graduated with a Bachelor of Science in Computer Information Systems from Alabama A&M University.