Michael Burmeister
Groton,MA
Summary
- Healthcare executive with proven expertise in stakeholder engagement and health plan leadership. Achievements include successful managed care strategies across Medicare Advantage, Medicaid, and Commercial sectors, resulting in significant service expansions. Proficient in process optimization and operational restructuring, with strong communication and negotiation skills. Dedicated to implementing innovative solutions in dynamic environments.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Sr. Director, Value-Based Care and Network
Central Mass Health LLC.
Worcester, Massachusetts
01.2025 - 06.2025
- Developed and executed value-based care and network strategy for Mass Advantage.
- Led negotiations for managed care contract renewals with providers and health system partners.
- Managed relationships and integration with UMass Memorial Health as key payvider partner.
- Accountable for performance of all value-based care programs, focusing on goals and risk structures.
- Identified opportunities for enhanced value orientation in provider contracting.
- Exceeded unit cost targets while maintaining robust network quality.
- Monitored operations and reporting of value-based care initiatives to ensure accountability.
Corporate Director, Network Strategy
AmeriHealth Caritas
Philadelphia, Pennsylvania
03.2021 - 01.2025
- Built leadership team for Enterprise Network Strategy to enhance growth and network value.
- Collaborated across business functions to implement programmatic solutions and standardized tools.
- Surpassed optimization goals with actual values 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, three new Medicare, and three ACA/Exchange markets.
- Established infrastructure and operational reporting to support strategic execution and financial negotiations.
- Evaluated financial results and gathered market intelligence to pinpoint performance improvement opportunities across multiple lines of business.
General Manager, CareMore Aspire
Elevance
Hartford, Connecticut
09.2016 - 12.2020
- Directed business and operational strategies with full P&L accountability for market performance.
- Promoted in 2018 from Provider Collaboration Programs Director due to consistent performance across growth, quality, and profitability initiatives.
- Increased engaged patient numbers by over 200% through expanded co-management care model.
- Developed and launched CareMore's first commercial product, serving 2,000 patients.
- Analyzed existing product offerings and evaluated market opportunities for future 'at-home' services.
- Transitioned care coordinators from in-person to remote operations by collaborating with Aspire operations team.
- Achieved significant improvements in key metrics; increased annual wellness visits by 200%, HEDIS scores by 116%, and SOAP note completion by 967% from 2016 to 2017.
Market Director, Operations and Engagement
Humana
Richmond, Virginia
03.2013 - 09.2016
- Led Medicare strategies and operations for 140,000 lives in Mid-Atlantic Region.
- Directed external team engagement with providers to enhance clinical and financial outcomes.
- Achieved reduction in medical expense ratio from 87.6% to 84.4% through targeted initiatives.
- Expanded business into two new Medicare markets and Virginia MLTSS program.
- Executed market share growth strategies, improving quality and generating margin for region.
- 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
UC Berkley
Skills
- Performance accountability
- Business development
- Stakeholder engagement and relations
- Value-based contracting
- Population health strategies
- Data-driven decision making
- Quality improvement initiatives
Certification
- 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
UC Berkley
Similar Profiles
Diane CameronDiane Cameron
LPN Telephone Triage at Women's Health Of Central MassLPN Telephone Triage at Women's Health Of Central Mass
ANGELICA RODRIGUEZANGELICA RODRIGUEZ
Community Engagement Specialist at Girl Scouts of Central and Western MassCommunity Engagement Specialist at Girl Scouts of Central and Western Mass
Kathleen M NevinsKathleen M Nevins
Registered Nurse at VA Central Western MassRegistered Nurse at VA Central Western Mass
Jeffrey SekeraJeffrey Sekera
Sr. Product Owner: TruCare Cloud UM Rulesets and UM Automation at CetneneSr. Product Owner: TruCare Cloud UM Rulesets and UM Automation at Cetnene
Sean SeggertySean Seggerty
Assistant Director at Chick-Fil-A NashuaAssistant Director at Chick-Fil-A Nashua