Solutions for Fraud, Waste & Abuse and Utilization Management
One hour of CE ETHICS credit for Kansas is available and Missouri is pending to 2016 members.
Our speaker will be David Buchanan, JD, CPM, who, as a Business Development Senior Consultant for Dell, is the Practice Lead for Dell Services’ health plan solutions for health insurance exchanges, revenue optimization (fraud waste and abuse, coordination of benefits, subrogation), utilization management, and care/case management.
He will discuss the key challenges for health plans and provide examples of typical fraud, waste & abuse (FWA) cases that have been encountered. He will offer real solutions for health plans and discuss the purpose of utilization management.
David Buchanan is an accomplished executive and consultant with over 25 years of strategic organizational management and leadership experience in the private and government sectors. In his current role, he provides strategic policy direction, guidance, and leadership to health plans as part of the Health Plan Innovation and
Consulting team.
Prior to his current position, he served in key private sector healthcare executive roles, including more recently as a senior consultant and subject matter expert for CSG Government Solutions in their leadership and implementation of health insurance
marketplaces in Mississippi and Iowa. Additionally, he served as the Vice President of Compliance & Regulatory Affairs for Centene Corporation’s Magnolia Health Plan subsidiary, leading the Mississippi’s Medicaid program successfully into the managed care environment. Before Centene, he served as the Government Programs Manager for McKesson Health Solutions by leading its disease management and nurse triage services for Medicare in
Mississippi, for Medicaid in California, Tennessee, and Montana, and for Tricare in western Europe. He also was the Director of Member Services with the Mississippi Health Care Association, the state’s trade organization for nursing homes and assisted living.
On the public side, he served for over eight years at the Mississippi State Department of Health, first as Director of Policy & Planning serving as the agency’s lobbyist and policy director and the last two years as Director of Licensure. Additionally, he had served in key management roles and an administrative law judge at the state’s Department of Human Services and its Economic Development Authority.
A native of Shreveport, Louisiana, he received his B.S. degree in finance from Louisiana State University and his law degree from Mississippi College School of Law. While in state government, he received the designation of Certified Public Manager (CPM), for excellence and knowledge in government management and
administration.
There is a 48 hour cancellation policy.
Presented by:
