Dr. Glenda E. Flemister - Pulmonary Medicine, Critical Care Medicine Doctor
Glenda E. Flemister, MD, FACP, FCCP
IL. KY, NM, OK USA

Glenda E. Flemister, MD, FACP, FCCP, is Board Certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine. Dr. Flemister has over 30 years of experience in her field. She received her MD from Loyola University Chicago Stritch School of Medicine and is licensed to practice in Illinois, Kentucky, New Mexico, and Oklahoma.

Dr. Flemister has over 12 years of experience in national insurance and payer companies. She has served as Medical Director for Aetna, Blue Cross Blue Shield Association, and Next Level Health Partners. She is currently the Executive Medical Director for Medical Health Solutions, a company involved in predicting trends to optimize healthcare at an affordable and sustainable rate. In this capacity, she provides education, consultation, and resources to the medical industry, medical providers, and managed care organizations.

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Certification and Licensure

Medical License

Illinois
Kentucky
Oklahoma
New Mexico

Professional Experience

PROFESSIONAL ASSOCIATIONS


  • American College of Chest Physicians
  • Society of Critical Care Medicine
  • American College of Physicians
  • American Thoracic Society
  • American College of Physician Executives
  • Institute of Medicine of Chicago
  • Chicago Asthma Consortium
Education | Glenda E. Flemister, MD, FACP, FCCP

Education

  • Northern Illinois University, DeKalb, IL; Received Bachelor of Science             
  • Loyola University Stritch School of Medicine, Maywood, IL; Received Doctor of Medicine
Training | Glenda E. Flemister, MD, FACP, FCCP

Training

  • Internal Medicine Internship,Columbus Hospital, Chicago, IL.
  •  Internal Medicine Residency Michael Reese Medical Center, Chicago, IL.
  •  Pulmonary Medicine and Critical Care FellowshipHines Veterans Affairs Hospital, Hines, IL.
Specialties | Glenda E. Flemister, MD, FACP, FCCP

Specialties

  • Pulmonary Medicine
  • Critical Care Medicine
  • Peer Reviews
  • Appeal Reviews
  • Utilization Reviews
  • Litigation Support

Special Projects and Committees

  • Aetna’s Clinical Policy Bulletin

    As a member of this committee for 7 years, we review, updated and revise Aetna policies, procedures, and covered benefits. All policies are vetted in this committee, including all medicals, surgical, device, technology and claims issues.

  • Condition Analysis in Pulmonary Medicine

    I reviewed pulmonary topics for trending. This includes drug therapy, procedures, new techniques, and how this will impact Aetna. For example, I reviewed two (2) years of drug therapy for the drug Xoliar.

  • Specialty Society Committee

    I advise and provided to the Sub-specialty Society Committee and to Aetna senior leadership sub-specialty information from the national group, and leaders in the medical and surgical field.

  • Comparative Effectiveness Research (CER) Workgroup Meeting

    As a member of this committee I identified, evaluated and compared research opportunities and how these studies may impact Aetna, as well as coordinate comparative research activities within Aetna.

  • Ingenix Health Technology

    As a member of the committee, I brought the Ingenix data to Aetna and incorporate this new information technology and drug therapy so that it may be integrated into current management systems.

  • Lectures

    I have represented Aetna at local and national meetings, grand rounds and webinars. One national meeting was the World Congress where I was the chairperson, a workshop leader and presented a major lecture, “ Avoiding Hospital Re-admission and Improving Patient Care Strategies that work”.

Employment History

Provide clinical leadership for the utilization management process, including pre-authorization, denials and appeals, specialty and sub-specialty reviews with medical determinations. Provide clinical direction and guidance to nurses and other staff for utilization and interpretation of the protocols. Engage in provider relationships, provider reviews, establish special networks.
 

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Specialties


Pulmonary Medicine

Critical Care

Device Studies/Medical Reviews

Expert Witness