Michael R Dimayuga
About Candidate
Michael R Dimayuga, MD
13954 Plantation Valley Drive, Houston, TX 77083 – mdimayugamd20@gmail.com
Objective To participate as a team member of an organization where I can apply practical working knowledge as a Physician Reviewer for solutions that will change the way complex medical cases are adjudicated.
Experience Case Management/Utilization Management/ Utilization Review Medical Consultant
Florida Healthcare Plans
February 2017 – January 2024
Data Science Officer for FHCP through the COVID-19 pandemic, reporting to the highest levels of the company regarding admission numbers, case mix by gender, age, comorbidities, as well as LOS by age, gender, comorbidities, and vaccination status.
Conduct daily Utilization Review, Utilization Management, Case Management and Discharge Planning on admissions from over 27 area hospitals; advise other reviewers (RN and LPN) using MCG (Milliman Care Guidelines); Corporate Trainer for new UM/UR RN Reviewers; educate and train Physicians on Utilization Management principles and operations; Corporate Trainer for Physicians taking on new UMP (Utilization Management Physician) role.
Assist in managing the department. Development and implementation of policies and procedures to ensure NCQA and CMS compliance.
Work directly with Chief Medical Officer. Oversee and moderate weekly meetings for UR/UM and Readmission Taskforce; as well as maintain compliance with NCQA and CMS mandates.
Medical Liaison to Mayo Clinic Jacksonville.
Work with Physicians on an ongoing basis to inform, educate, and advise regarding patient care and hospital operations and changes.
Analyze data to determine areas of improvement for the company and medical staff.
Provide medical expertise for determining community, hospital, and patient needs to improve overall medical care provided within the community.
President and Operations Officer
Michael R and Eloisa G Dimayuga, MD, PA, Ormond Beach, FL
March 1996 – December 2016
Physician
Started new medical practice from the ground up. Manage all business operations. Handled clinical and business office functions. Credential management, contract review and management, IT implementation and oversight, staff management, marketing, revenue cycle management, implemented revenue generation strategies. Learned ICD and CPT language, learned billing and collections best practices.
Vice President, Founder, and Chief Operations Officer
Coastal Internal Medicine Specialists, LLC, Ormond Beach, FL
November 2001 – November 2010
Founder of Single-specialty Internal Medicine practice
Managed day to day operations. Responsible for staff management. Developed and implemented revenue generation strategies. Payer contract management. Marketing. Revenue cycle management. Strategized revenue stabilization in face of changing reimbursement models.
Physician
Competitive Soccer Coach
Ormond Beach Soccer Club, Ormond Beach, FL
1998 – 2006
Head Coach of competitive/travel teams, Girls U-10 to U-13
Third Place, Regional Cup Finals, FL, 1999
Clinical Instructor/Chief Resident, Department of Medicine
Yale University School of Medicine, New Haven, CT
July 1990 – June 1991
Instructed 3rd and 4th year medical students
Mentored and graded Interns and Medical Residents
Implemented curricular objectives for Internal Medicine Training Program
Education
Doctor of Medicine
University of the East College of Medicine, Quezon City, Philippines
April 1985
Dean’s List
Bachelor of Science (Zoology)
University of the Philippines – Diliman Campus, Quezon City, Philippines
April 1981
University of the Philippines – Government Scholarship
Dean’s List
Interests Teaching, coaching, Health and Wellness
References Mansueto Amolat, CMC USN (Ret) 386-804-0339 Stephen Keen, MD 904-415-5794
Joseph Zuckerman, MD 386-615-4087
Location
Education
Work & Experience
Data Science Officer for FHCP through the COVID-19 pandemic, reporting to the highest levels of the company regarding admission numbers, case mix by gender, age, comorbidities, as well as LOS by age, gender, comorbidities, and vaccination status. Conduct daily Utilization Review, Utilization Management, Case Management and Discharge Planning on admissions from over 27 area hospitals; advise other reviewers (RN and LPN) using MCG (Milliman Care Guidelines); Corporate Trainer for new UM/UR RN Reviewers; educate and train Physicians on Utilization Management principles and operations; Corporate Trainer for Physicians taking on new UMP (Utilization Management Physician) role. Assist in managing the department. Development and implementation of policies and procedures to ensure NCQA and CMS compliance. Work directly with Chief Medical Officer. Oversee and moderate weekly meetings for UR/UM and Readmission Taskforce; as well as maintain compliance with NCQA and CMS mandates. Medical Liaison to Mayo Clinic Jacksonville. Work with Physicians on an ongoing basis to inform, educate, and advise regarding patient care and hospital operations and changes. Analyze data to determine areas of improvement for the company and medical staff. Provide medical expertise for determining community, hospital, and patient needs to improve overall medical care provided within the community.