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MD Perspectives

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Hello colleagues,

We are launching an informative series of articles that will tell you about EmblemHealth’s and ConnectiCare’s Medical Directors, what we do to ensure your patients receive the right care at the right time, as well as other “Hot Topics.”

If there are other health topics you would like our perspectives on, please write to us at 

emblemhealthmedicaldirectors@emblemhealth.com.

While we welcome your suggestions, we ask that you do not send protected health information (PHI) or patient-specific issues to this mailbox. This mailbox should not be used for complaints, grievances, appeals, or claims inquiries. The Claim Inquiry and Message Center features in the provider portals (EmblemHealth|ConnectiCare) should be used for those issues.

Our Medical Directors

Headshot of Dr. Sandra Rivera-Luciano MD, MHSA

Sandra Rivera-Luciano

Sr. Medical Director, MD, MHSA

I am Dr. Sandra Rivera-Luciano MD, MHSA, and I serve as one of the Senior Medical Directors for both EmblemHealth and ConnectiCare. My specialty is General Pediatrics. I have been with the companies since 2018. My primary role is to serve as a Senior Medical Director under the leadership of both doctors Indulekha Warrier, Vice President of Medical Affairs & Chief Medical Officer, ConnectiCare, and Richard Dal Col, SVP, Chief Medical Officer for the EmblemHealth family of companies.

Kelly McGuire

Medical Director, MD, MPA

Kelly McGuire, MD, MPA serves as Medical Director of Psychiatry for EmblemHealth. In this role, she leads EmblemHealth’s behavioral health team, oversees services, and manages behavioral health strategy. Dr. McGuire is known for her extensive work in policy analysis, evidence-based practices, and systems of care. She also lends her expertise in behavioral health to aspiring healthcare professionals—most recently as keynote speaker at Queensborough Community College’s Certified Recovery Peer Advocate Conference—and to New Yorkers on local news network BronxNet. Prior to joining EmblemHealth, Dr. McGuire was an Assistant Professor of Psychiatry at Columbia University Irving Medical Center (CUIMC) and Medical Director of the Translational Medicine Program at the New York Presbyterian Hospital’s Center for Autism and the Developing Brain where she practiced clinically.

Utilization Management Team

EmblemHealth and Connecticare

We have a team of over 200 nurses and 11 physicians. All are licensed and hold utilization management certification by MCG, an organization that develops evidence-based review guidelines used by many provider communities and payers across the nation. In addition, our physicians are board certified in various fields of medicine including, but not limited to, Internal Medicine, Family Medicine, Pediatrics, OB-GYN, GYN Oncology, Palliative Care, Infectious Disease, and Occupational Medicine. We also collaborate with organizations that conduct utilization management for their own members as part of value-based arrangements, and with others that provide specialty specific expertise to supplement our own. We work closely with our provider communities, members, and UM partners to ensure access to high-quality care for all our members.

Browse Our Topics

Asian family senior mother and daughter cooking salad in the kitchen at home
Population Health

Learn about the unique perspective we, as medical directors for EmblemHealth and ConnectiCare, have on population health.
Female medical practitioner reassuring a patient
Clinical Considerations

We want to shift from fixing what is broken to preventing the damage in the first place or catching it as early as possible. 
Woman psychologist talking to patient woman. Therapist's gestures. Female talking in coworking office
Mental Health Matters

See how we can support you in treating members with mental health issues. 
Patients stretching in a gym class
Programs, Classes, and Resources

Learn about the programs, classes, and resources we offer and recommend for you.

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.