1. Marie F. Hatam, MD, MBA
3120 West Carefree Highway
Suite 1-700
Phoenix, Arizona 85086
Cell 602-618-7420
mhatam@hotmail.com
EDUCATION: Masters of Business Administration, 1999
Drexel University
Philadelphia, Pennsylvania
Doctor of Medicine, 1979
Cornell University Medical College
New York, New York
Bachelor of Arts, 1973
Vassar College
Poughkeepsie, New York
LICENSURE: Active: Arizona, Pennsylvania,
Expired Maryland, Delaware, New Jersey, Oklahoma, New Mexico
New York (inactive)
EXPERIENCE: Senior Medical Director 7/31/2015 to Present
Aetna- Federal Employee Health Benefit Plan (Fee for Service), Scottsdale, AZ
• Supervise 6 Medical Directors dedicated to the Fee for Service FEHB Plans
o Oversight of medical director activity for Prior Authorization, Concurrent
Review, Behavioral Health, Quality Committee, and Case Management.
o Medical Director Liaison to the Three FEHB Plans
o Participate in Aetna Musculoskeletal Cost Containment Committee
o Participate in Aetna P4P and Bundled Payment Committees
o Participate in Aetna National Precert List Committee
o Pharmacy Benefit Program Liaison for all Three FEHB Plans
Medical Director 7/15/2013 to 7/31/2015
Aetna- Federal Employee Health Benefit Plan (Fee for Service), Scottsdale, AZ
Medical Management Services.
• Medical Director for utilization management, Subject Matter Expert for spinal review
program, musculoskeletal fraud and abuse
• Member of Aetna Musculoskeletal Cost Containment Committee
• Member of Aetna Orthopaedic P4P program development Committee
CCR Medical Director (Virtual) 1/8/2013- 7/5/2013
United Health Care, Phoenix, AZ
• Medical Director for Pre-service reviews for Individual and Employer Accounts
Medical Director 9/2012-12/2012
Arizona Priority Care Plus, Phoenix, AZ
• Medical management for Managed Medicare population including UM, SNF program,
support provider contracting, and provider support for patient care facilities.
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2. • Clinical practice – part time for AZPCP outpatient clinic until 6/13.
CCR Medical Director (Virtual) 3/2012 to 8/2012
United Health Care, Phoenix, AZ
• Medical Director for Pre-service reviews for Individual and Employer Accounts
Orthopaedic and Occupational Medicine Physician (Clinical) 8/1/2011-2/21/2012
US Health Works, Phoenix, AZ
• Orthopaedic consultant and occupational physician for for 4 occupational medicine
clinics in Phoenix and Tucson, AZ
Orthopaedic Consultant
ARGO Group 11/1/2010-01/2013
• Orthopaedic consultant for a National Workers' Compensation Insurance Company
Center Medical Director (Administrative and Clinical)
Concentra Medical Center, Las Cruces, NM 7/2010 to 7/2011
• General Occupational Medicine Clinic and Urgent Care practice with emphasis on
musculoskeletal disorders. Providing medical leadership to the clinicians, and ancillary
medical staff. Support for marketing and client relations.
Clinical Practice as Office Only Orthopaedic Surgeon (Clinical)3/2009 to 7/2010
Foothills Medical Center
Rehabilitation & Occupational Medicine, Las Cruces, NM
• Outpatient general practice with emphasis on non-operative musculoskeletal care and
occupational medicine, pain management
General Outpatient practice and Medical Director for (Clinical)10/2008 to 2/ 2009
Community Healthcare of Douglas clinic, Douglas, AZ
• Practicing general outpatient medical care and responsible for the clinic medical providers.
Medical Review Officer for the Pentagon Force Protection Agency (PFPA) and Medical
Officer in the Di Lorenzo Occupational Health Clinic, Pentagon, Washington, DC 1/2008 to
9/2008. (Administrative and Clinical)
Columbia Arora Joint Venture Group: independent consultant assigned to the Pentagon
• Directly responsible for the Pentagon Police Officers fitness for duty, work injury
evaluation and treatment and medical program oversight, including review of other
occupational health physicians’ work for PFPA program.
• Provide occupational health evaluation and treatment for the Pentagon Civilian and
Contractor employees.
• Credentialed by Walter Reed Army Medical Center as an Occupational Health Provider
Associate Chief Medical Officer 9/07-11/07
Aetna/Schaller Anderson-Mercy Care Plan, Phoenix, AZ
• Directly responsible for Utilization Management Program
• Supervised six Medical Directors
• Medical director oversight of the ALTCS population
Senior. Medical Director, 3/2007-8/2007
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3. Schaller Anderson-Mercy Care Plan
Phoenix, Arizona
• Utilization management for managed Medicaid and Medicare plan
• Vendor management and contracting support for O&P and DME-Medical Director
• support for UM/QM and Pharmacy Committees,
• Medical lead for Schaller Anderson/Mercy Care Arizona Long Term Care (ALTCS)
program and Transplant Team.
• Interfaced with behavioral health department
• Attended AHCCCS Medical Directors’ meetings
• Supported the QM department programs
Medical Director, January 2007
United Health Care-APIPA- Tucson, Arizona
• Utilization management for managed Medicaid Plan
Lead Medical Director, March2006 to December 2006
Cigna Group Insurance, Disability
Dallas, Texas
Lead Medical Director for Dallas and Glendale Offices
• Medical management of disability claims
• Review of medical information for disability claims
• Conduct multidisciplinary team reviews
• Provide medical support for appeals process
• Manage medical directors in Dallas, TX. and Glendale, Ca.
Vice President and Medical Director, 2003-2006
The PMA Insurance Group
(workers’ compensation and disability insurance company)
Blue Bell, Pennsylvania
Direct responsibility within Managed Care Department:
• Direct oversight for Case Management Quality Management Programs, including
the activities of the Manager and Medical Nurse Specialists
• Physical Therapy Cost Containment Project manager
• Medical Utilization Management and Reporting
• New State Expansion Medical Management Program Development and Regulatory
Compliance
• Medical Director support for Medical Bill Review:
Multi-State medical director support for Workers’ Compensation and Disability lines
of business, including:
• Medical cost containment initiatives
o Pharmacy utilization
o Pain management
o Physical Therapy
• Medical Education
o Developed medical education programs for nurses and adjusters
o Delivered multi-state educational presentations
• Catastrophic medical case management
• Company expansion initiatives
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4. o Developed utilization review process
o Formed physician advisory panel
o Developed Quality oversight of physician advisers
• Vendor management
• Medical director support for claims case management and disability cases
VP of Medical Affairs & Medical Director, 2001-2003
Medical Director 2000-2001
Coventry Health Care of Delaware, Inc.
Wilmington, Delaware
Direct responsibility for HMO and State Managed Medicaid & Medicare:
• Quality Management Department, Quality Improvement Committee, & Plan
preparation for URAC Accreditation (received full URAC Accreditation);
• Medical Directors & Medical Project Manager;
• Physician Profiling (INGENIX and homegrown)
• Disease Management Programs
• Utilization Management / Quality Management Committee (Committee Chair)
• Provider Credentialing & Ancillary Credentialing Committees
• Quality of Care process & profiling
• Peer Review process & profiling
• Medical Director support for appeals and reimbursement disputes, including:
o Review physician, hospital and ancillary provider bills against system
coding edits
o Provide medical documentation for coding reimbursement decisions and
dispute/appeals resolution
Other responsibilities:
• Conduct Utilization management process using InterQual criteria & Case
Management for Commercial & Managed Care Government programs, including
Medicaid & Medicare;
• Developed cost containment initiatives for complex case management;
• Developed wrap around model for SNF & Acute Hospital “hospitalist” program;
• Supported committees, including Delegation & Vendor Oversight, Compliance,
Government Programs, HIPAA
• Participated on Medical Expense & Trend Analysis/Reporting Committee,
Information Systems, & Claims Quality Review.
Regional Network Medical Director, 9/1999-9/2000
Horizon Blue Cross Blue Shield of New Jersey
Marlton, New Jersey
• Developed & managed physician group risk network for Southern New Jersey
region;
• Analyzed provider utilization data & educated providers on improving their
efficiencies;
• Performed utilization management using Milliman & Robertson Guidelines
• Provided Medical support for prior-authorization & case management
• Participated on Medical Policy Committee.
• Provided Medical Director support for appeals and reimbursement disputes,
including:
o Reviewed physician, hospital and ancillary provider bills against system
coding edits
o Provided medical documentation for coding reimbursement decisions
Medical Director for Managed Care Services, 1/1999-9/1999
Frankford Hospital Health System
Philadelphia, PA
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5. • Managed provider risk network;
• Developed disease management programs;
• Analyzed provider utilization data & educated providers on improving their
efficiencies;
• Developed & managed data management, statistical analysis & reporting for
hospital & physician network.
Medical Director (part time while completing MBA), 1998
HIP, NY, NY
• Utilization management reviewer
Medical Director, 1998
Trigon BCBS / HealthKeepers
Richmond Virginia
• Medical Director for HMO Central; reviewed & created medical policy;
• Provided Medical Oversight of GMIS integration with Claims System
• Medical Director support for appeals and reimbursement disputes, including:
o Review physician, hospital and ancillary provider bills against system
coding edits
o Provide medical documentation for coding reimbursement decisions and
dispute/appeals resolution
• Participated on Pharmacy Committee (P&T) & Medical Policy Committee
• Performed utilization management using Milliman & Robertson Guidelines
• Provided Medical support for prior-authorization & case management
• Member of Medical Policy Committee for developing medical policies to support
Utilization Review process and claims adjudication
• Panel Member, Medical Policy Panel for National Accounts, National Blue Cross &
Blue Shield Association
• Chair, Credentialing Committee
Medical Director and Senior Medical Director
Independence Blue Cross, 1993-1998
Philadelphia, Pennsylvania
Senior Medical Director for Medical Policy, 1996 – 1998
(Independence Blue Cross Blue Shield)
• Developed Medical Policy & Technology Assessment Department for Utilization
Review process and claims adjudication
• Provided oversight & managed policy development for HMO, Indemnity,
Government Programs Managed Medicaid and Medicare & PPO products;
(policies included appropriate treatment, procedures, new technologies & durable
medical equipment (DME)
• Managed & directed Sr. Policy Manager, Policy Coordinators, & Policy Assistants
• Managed & directed four full-time and six consulting Medical Directors for
Utilization Review & Medical Policy
• Managed Provider Appeals Department, including medical appeals and claims
adjudication appeals based on system edits (GMIS)
• Medical Director support for appeals and reimbursement disputes, including:
o Review physician, hospital and ancillary provider bills against system
coding edits
o Provide medical documentation for coding reimbursement decisions and
dispute/appeals resolution
• Panel Member, Medical Policy Panel for National Accounts, National Blue Cross
Blue Shield Association
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6. Medical Director, 1995 - 1996
CompServices, Inc. (an Independence Blue Cross company)
• Medical Director for third party administrator (TPA) for managed worker’s compensation;
• Provided oversight for utilization review & case management
Medical Director, 1993 – 1996
(Independence Blue Cross Blue Shield)
• Provide oversight & utilization management using Milliman & Robertson Guidelines &
OptiMed criteria for managed care products, including Indemnity, PPO & HMO
• Medical Director support for appeals and reimbursement disputes, including:
o Review physician, hospital and ancillary provider bills against system coding edits
o Provide medical documentation for coding reimbursement decisions and
dispute/appeals resolution
• Designed & implemented managed care & case management systems including:
o Total Joint Replacement Management Program
o Restorative Care Utilization Review Program
• Medical Advisor to Human Resources Department on disability, Family Medical Leave Act
(FMLA), & Workers’ Compensation
Orthopaedic & Occupational Medicine Practices, 1990 - 1994
Diagnostic Orthopedic Services (1992-94)- own practice in New Jersey and Pennsylvania
• Provided non-operative orthopaedic treatment & consultation, both pre- & post-
operatively.
• Provided case management of musculo-skeletal injuries.
• Presented educational seminars on musculo-skeletal topics (e.g., carpal tunnel
syndrome, low back disorders, etc.).
• Performed occupational medicine evaluations.
• Performed prospective & retrospective medical reviews of medical records.
• Performed prospective ergonomic site surveys & designed intervention programs
for industry.
Riverfront Medical Services (1990-91) in New York
Non-operative orthopedic office only; IME’s; work related injuries; case management
Ergonomic work site evaluations
Orthopaedic Surgeon, 1984 - 1989
Olean Medical Group, Olean, New York (1984-1987),
Southern Plains Medical Group, Chickasha, Oklahoma and Northwest Oklahoma Specialty Group,
Woodward, Oklahoma (1987-1989)
• General orthopaedic surgery practice; included
o Trauma,
o Joint replacement,
o Sports Medicine,
o Pediatric
o Hand Surgery.
o Workers’ Compensation
Practice included frequent presentations to community & civic groups on orthopaedic topics, such as
arthritis & carpal tunnel.
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7. COMPUTER
SYSTEMS
Optimed, InterQual, MeDecision, AMISYS, GMIS Code Review, MCG Guidelines, MiniTab
Statistical Software, Microsoft Office Suite (Word, Microsoft Excel, Power Point); Project
Management courses 2000, 2007.
CERTIFICATION Recertified until 12/31/2020
Board Certified, 1989
American Board of Orthopaedic Surgery
Chicago, Illinois
Board Certified, 1991
American Board of Quality Assurance & Utilization Review
Tampa, Florida
Diplomate, 1981
National Board of Medical Examiners
Philadelphia, Pennsylvania
POST-GRADUATE
TRAINING:
International Spine Intervention Society course in
Spine Anatomy and Imaging November 2010, San Francisco, CA.
International Spine Intervention Society course in Cervical Spine intervention pain
management techniques October 2010, Chicago, IL
International Spine Intervention Society course in Lumbar Spine intervention pain
management techniques January 2010, Phoenix, AZ
Basic Curriculum in Occupational Medicine Segments 1, 2 & 3 (Completed Certificate 2009)
ACOEM
New York, NY and Chicago, Ill
ACOEM-AMA Impairment Guides 6th Edition Course and Commercial Drivers
License Course,
7/2009.Chicago, Ill
Occupational Medicine Mini-Residency, 1991
University of Medicine & Dentistry of New Jersey
Piscataway, New Jersey
Chief Resident, Orthopaedic Surgery, 1983 - 1984
University of Medicine & Dentistry of New Jersey
Newark, New Jersey
Orthopaedic Surgery Residency, 1980 - 1983
University of Medicine & Dentistry of New Jersey
Newark, New Jersey
Surgical Internship, 1979 - 1980
University of Medicine & Dentistry of New Jersey
Newark, New Jersey
PROFESSIONAL
MEMBERSHIPS
American College of Occupational and Environmental Medicine
Advisor for Health Care Board of Bryan University, Phoenix, AZ
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8. PUBLICATIONS
AND
PRESENTATIONS
Musculoskeletal Overview & Quality Metrics in Managing and Evaluating Healthcare Intervention
Programs, 2nd edition 2014
Poster Session, The Role of Healthcare Informatics Simulation in Medical Education, Harvard
Medical School Medical Education Day, 10/2013
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