Michael Burmeister
Groton,MA
Summary
- Healthcare executive with proven expertise in customer success and health plan leadership. Successfully implemented managed care strategies across Medicare Advantage, Medicaid, and Commercial sectors, resulting in significant service expansions. Skilled in process optimization and operational restructuring, with strong communication and negotiation capabilities. Dedicated to fostering innovative solutions in dynamic environments.
Overview
12
12
years of professional experience
1
1
Certificate
Work History
Sr. Director, Value-Based Care and Network
Central Mass Health LLC.
Worcester, Massachusetts
01.2025 - 06.2025
- Formulated a strategy for provider reimbursement programs to enhance organizational competitiveness, driven by market trends and forecasting.
- Led negotiations for managed care contract renewals with providers and health system partners.
- Assessed and analyzed impact of pharmacy and care delivery strategies, implementing adjustments to achieve desired results.
- Implemented initiatives to elevate quality of care and enrich patient experience within specialty networks and referral processes.
- Cultivated relationships and facilitated integration with UMass Memorial Health as primary payvider partner.
Corporate Director, Network Strategy
AmeriHealth Caritas
Philadelphia, Pennsylvania
03.2021 - 01.2025
- Built and led a team to execute strategic account plans, financial modeling, and implementation pathways for enterprise outcomes.
- Communicated P&L levers and collaborated across business functions to implement standardized tools for enhanced account performance.
- Surpassed corporate optimization goals with actuals of $62M, $152M, and $119M against targets of $40M, $140M, and $85M from 2022 to 2024.
- Executed provider network builds for entry into four new Medicaid markets, three Medicare markets, and three ACA/Exchange markets.
- Guided directors through strategic alignment by establishing clear goals and fostering trusting relationships for decision influence.
- Administered clinical vendor relationships, emphasizing adherence to contracts, managing renewals, and conducting evaluations.
- Evaluated financial results and gathered market intelligence to identify performance improvement opportunities across multiple business lines.
General Manager, CareMore Aspire
Elevance
Hartford, Connecticut
09.2016 - 12.2020
- Orchestrated business and operational strategies with P&L accountability for market performance.
- Cultivated new payer partnerships encompassing national health plans and managed care entities.
- Promoted in 2018 from Provider Collaboration Programs Director due to exceptional performance.
- Expanded co-management care model, increasing engaged patient numbers by over 200%.
- Initiated CareMore's first commercial offering, reaching 2,000 patients at home.
- Outperformed annual revenue expectations via robust partnership development and comprehensive business expansion strategies.
- Transitioned care coordinators to remote operations by collaborating with Aspire operations team.
Market Director, Operations and Engagement
Humana
Richmond, Virginia
03.2013 - 09.2016
- Managed Medicare initiatives and operations impacting 140,000 lives in Mid-Atlantic Region.
- Articulated value of medication management and pharmacy solutions, focusing on STAR ratings, HEDIS performance, cost containment, and member outcomes.
- Achieved reduction in medical expense ratio from 87.6% to 84.4% through targeted initiatives.
- Extended business operations to encompass two new Medicare markets and Virginia MLTSS program.
- Executed market share growth strategies, improving quality and generating margin for region.
- Led a team of high-performing, customer-facing Provider Engagement Executives.
- Identified and implemented improvements to existing Customer Success processes and leadership capabilities to ensure success.
- Drove value-based contract opportunities focused on quality improvement and cost reduction.
- Designed programs to close clinical care gaps and improve provider documentation practices.
Education
Bachelor of Science - Business Administration, Psychology
The College of New Jersey
Executive Education - Accelerating Change Readiness and Agility
University of California - Berkeley
Skills
- Performance accountability
- Customer success
- Change management
- Business development
- Stakeholder engagement
- Value-based contracting
- Population health strategies
- Data-driven decision making
Work Preference
Work Type
Full TimeLocation Preference
On-SiteRemoteHybridCertification
- PAHM – Professional, Academy for Healthcare Management
- HFMA – Healthcare Financial Management Association, Massachusetts-Rhode Island Chapter
Timeline
Sr. Director, Value-Based Care and Network
Central Mass Health LLC.
01.2025 - 06.2025
Corporate Director, Network Strategy
AmeriHealth Caritas
03.2021 - 01.2025
General Manager, CareMore Aspire
Elevance
09.2016 - 12.2020
Market Director, Operations and Engagement
Humana
03.2013 - 09.2016
Bachelor of Science - Business Administration, Psychology
The College of New Jersey
Executive Education - Accelerating Change Readiness and Agility
University of California - Berkeley
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