Bayley A. Raiz
Palm Springs,USA
Summary
Experienced healthcare executive with expertise in managed care operations, behavioral health systems, population health strategy development, social drivers of health (SDOH) interventions, Medicaid/Medicare program oversight, quality improvement, and regulatory compliance. Skilled in building high-performing teams, driving system-wide innovations, and establishing partnerships to enhance service delivery, reduce disparities, and improve fiscal sustainability. Committed to achieving exceptional results for long-term organizational success.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Vice President, Medicaid Strategy and Initiatives
HealthBegins
06.2024 - 03.2025
- Led consulting engagements for state Medicaid agencies, providers and health plans focused on managed care operations, health equity, and SDOH.
- Oversaw advisory and consulting services, driving P&L growth from $4M to $7M within 18 months while expanding service offerings in new geographies and practice areas.
- Provided expert guidance on regulatory readiness, contract performance, and SDOH network development for care delivery providers, health plans and community based organizations.
- Spearhead multi-sector partnerships, supporting health plans, providers, and community based organizations in implementing value-based care, risk-based contracting, and population health analytics.
Executive Director, Enterprise Health Equity
CVS Health
08.2022 - 06.2024
- Developed and implemented population health interventions, provider network strategies, and value-based care innovations to address health disparities.
- Directed enterprise-wide health equity strategies touching 40M Aetna members, 108M Caremark PBM beneficiaries, and 10M direct care delivery patients.
- Integrated behavioral health and SDOH across multiple setting to improve access and outcomes.
- Oversaw investment strategies aligning benefit design with community-based services.
Director, Medicaid and Vulnerable Populations
Kaiser Permanente
12.2019 - 08.2022
- Led Medicaid and complex care model of care strategies for 12M members across eight markets.
- Reduced acute and emergency costs by $45M while enhancing behavioral health outcomes and compliance.
- Standardized care management for 1,800 employees across multiple markets.
Executive Director, Mental Health and Social Care
Providence Health
06.2017 - 12.2019
- Developed and implemented $25M behavioral health strategy, reducing emergency care use by $16M.
- Led governance for behavioral health transformation in internal and community governance structures.
- Orchestrated integration of mental health services for 8M patient system, including partnerships with government, health systems, and social service agencies and investing in key services areas.
Principal and Founder
RAIZ CONSULTING, LLC
01.2006 - 06.2017
- Provided consulting for Medicaid managed care plans, FQHCs, and community organizations, focusing on value-based payment models, accreditation, and health system transformation.
- Led interim executive roles, including chief compliance officer, chief operations officer, and clinical director, for Medicaid plans and safety-net healthcare providers.
Senior Director, Quality
Community Health Plan of Washington
03.2013 - 03.2017
- Oversaw quality, accreditation, and value-based care for Medicaid and Medicare health plan, serving community health center, safety-net providers.
- Drove 400% improvement in Medicare HEDIS, CAHPS, HOS, and risk adjustment capture rates, elevating Medicare STAR rating from 2.5 to 4.5 by executing $10M population health program.
- Directed $30M value-based care program, increasing primary care use by 10%, reducing non-urgent emergency service visits by 2%, and lowering inpatient length of stay by 8%.
- Managed team of 62 FTEs, executing multi-pronged approach to quality improvement, provider engagement, and risk adjustment optimization.
Market Vice President Clinical Quality
UNITEDHEALTH COMMUNITY AND STATE
01.2011 - 03.2013
- Directed quality management for Medicaid and D-SNP programs in Washington State, overseeing plan accreditation, care management, and risk adjustment strategies with successful launch within 120 days.
- Led compliance readiness audit at 96% and resolved underperforming performance measures within 90 days of reporting achieving minimum performance level (MPL) thresholds on all 60 measures.
- Orchestrated 300 employees across matrixed shared service teams, including care management, population health, quality improvement, and regulatory teams.
Head of Population Health and Quality
ALAMEDA ALLIANCE FOR HEALTH
01.2010 - 01.2011
Director of Quality and Network Management
CONTRA COSTA HEALTH PLAN
01.2008 - 01.2010
Chief Compliance and Quality Officer
NAPA COUNTY HEALTH AND HUMAN SERVICES
01.2006 - 01.2008
Director of Quality and Compliance
HEALTHRIGHT360
01.2003 - 01.2006
Education
Doctor of Health Science - Population Health
Doctor of Behavioral Health - Care Management
Master of Business Administration - Healthcare
Master of Social Work - Bachelor of Social Work
Skills
Healthcare Executive
Market Growth
Population Health
System Transformation
Certification
CALIFORNIA BOARD OF BEHAVIORAL SCIENCES, Licensed Clinical Social Worker (LCSW)
AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES (ACHE), Fellow (FACHE)
NATIONAL ASSOCIATION HEALTHCARE QUALITY, Certified Professional in Healthcare Quality (CPHQ)
COMMISSION FOR CASE MANAGEMENT CERTIFICATION, Certified Case Manager (CCM)
Timeline
Vice President, Medicaid Strategy and Initiatives - HealthBegins
06.2024 - 03.2025
Executive Director, Enterprise Health Equity - CVS Health
08.2022 - 06.2024
Director, Medicaid and Vulnerable Populations - Kaiser Permanente
12.2019 - 08.2022
Executive Director, Mental Health and Social Care - Providence Health
06.2017 - 12.2019
Senior Director, Quality - Community Health Plan of Washington
03.2013 - 03.2017
Market Vice President Clinical Quality - UNITEDHEALTH COMMUNITY AND STATE
01.2011 - 03.2013
Head of Population Health and Quality - ALAMEDA ALLIANCE FOR HEALTH
01.2010 - 01.2011
Director of Quality and Network Management - CONTRA COSTA HEALTH PLAN
01.2008 - 01.2010
Principal and Founder - RAIZ CONSULTING, LLC
01.2006 - 06.2017
Chief Compliance and Quality Officer - NAPA COUNTY HEALTH AND HUMAN SERVICES
01.2006 - 01.2008
Director of Quality and Compliance - HEALTHRIGHT360
01.2003 - 01.2006
THOMAS JEFFERSON UNIVERSITY - Doctor of Health Science, Population Health
ARIZONA STATE UNIVERSITY - Doctor of Behavioral Health, Care Management
AMERICAN INTERCONTINENTAL UNIVERSITY - Master of Business Administration, Healthcare
WIDENER UNIVERSITY - Master of Social Work, Bachelor of Social Work
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