Executive Resume

Jeffrey A. Baumeister, CHC

Folsom, CA 95630 Telephone: (916) 351-9181 Email: jeff.baumeister@gmail.com

Leadership Profile
Outstanding track record of improving profitability by developing and implementing innovative programs to address complex operating problems. Seeking leadership opportunity with a leading health plan, managed care organization, benefits purchaser, medical group or integrated delivery system. Significant experience with startup, build and implementation of new programs including Medi-Cal Two Plan Model, Medi-Cal Rural Expansion, Medicare Advantage Plans, Health Insurance Exchanges and startup provider sponsored commercial health plans. Business Development: Key member of six person BD team that won $26.5M contract to file Knox-Keene license application and built startup health plan for Sutter Health. P&L and Operations: Served as GM with responsibility for $500M Medicaid P&L for major CA Health Plan increasing revenues by $52M. Medicare: Led multi-disciplinary project team that developed and implemented Group Medicare Advantage Prescription Drug Plan for CalPERS retirees on a six month build timeline. Knox Keene: Led team that developed and filed successful full service Knox Keene Application and subsequently built sales operations for startup Sutter Health Plan. Cost of Healthcare: Developed and implemented Cost of Healthcare program for 500k member CalPERS account that bent the trend saving $16M/year. RFP Wins/Account Management: Successful experience with new business development and large scale RFPs as well as managing and expanding large group employer and government contracts including CalPERS, State of Ohio, Department of Defense, GM, Ford and Chrysler. Health Plan Transformation: Appointed by CEO to lead enterprise wide transformation of Blues Plan implementing risk based provider contracts, new benefit plans and enhanced UM/DM programs resulting in $12M+ annual savings. Thirty years of broad based payer and provider experience including marketing, business development, provider network development, regulatory compliance, service area expansions, licensures, claims audits, call centers and health plan operations with industry leaders including several Blues, United Healthcare, Aetna, Foundation Health and Health Net. Proven ability to bring order out of chaos and develop and implement new internal progra ms, restore regulatory compliance, design and operationalize new products, open new markets, improve operating efficiencies, reduce administrative expenses, create narrow provider networks, expand service areas and better control healthcare costs.

Professional Experience
California Health & Wellness Plan Director Provider Relations Sacramento, California 2013

Plan, develop and implement all provider relations and education activities for startup health plan serving 93,000 Medi-Cal beneficiaries in 18 county Rural Expansion of Medi-Cal managed care. Optum Consulting/ United Health Group Director, West Region Payer Consulting Sacramento, California 2011 to 2013

Responsible for new business development for health plan/payer accounts of $2.5M+. Key member of senior executive business development team that sold and delivered on $26.5M engagement with Sutter Health to build startup commercial health plan.

MedeAnalytics Client Success Executive/Senior Director

Emeryville, California 2011

Cultivated relationships with largest health plan clients for this privately held data analytics firm. Developed and executed account management plans, annual training roadmaps, all medical director in-service trainings, identified product enhancements, and managed service request and new release schedule. Blue Shield of California (BSC) Director, Healthcare Value Sacramento, California 2007 to 2010

Developed new initiatives/health benefit products reducing cost of healthcare for CalPERS with projected cost savings of $16 million in 2010. Within a 120 day window, developed and implemented fourth largest group Medicare advantage prescription drug plan (GMAPD) in California as the retiree health care solution for California Public Employees Retirement System (CalPERS) account. Insight Health Corporation Lake Forest, California VP Managed Care, Director Business Development/Managed Care Contracting 2005 to 2007 Significantly revised managed care payer contract language and reimbursements to drive new revenues, improve operating efficiencies and obtain regulatory compliance. CHC Managed Healthcare Consulting Vice President Business Development and Client Services Sacramento, California 1998 to 2005

Designed, marketed, and implemented comprehensive healthcare contract services for managed-care payers and providers. Developed marketing materials, sales forecasts, industry research, identified target markets, product line enhancements and formed strategic alliances. Served clients Health Net, Foundation Health, PacifiCare and Blue Shield of California. Health Net Vice President/General Manager, California Health Programs Rancho Cordova, California 1998

P & L leadership for $500 million annual revenue Medi-Cal programs throughout California. Managed 130 employees and directed a $6 million annual budget. Directed all sales and marketing, enrollment, member services, health education, medical management, government relations, claims, finance, provider development, compliance and administrative operations. Increased revenues by 10 percent$52,000,000to a total of $480 million per year. Coopers & Lybrand, LLC Director, HMO Compliance Sacramento, California 1997

Direct responsibility for developing a comprehensive new product line of compliance consulting services for marketing to managed care organizations for the C & L Health Care Regulatory Group Practice. Developed marketing materials, designed and implemented audit procedures, best practices, pricing policies and performance standards. Foundation Health, a California Health Plan Vice President, Provider Compliance and Education Sacramento, California 1995 to 1997

Total P & L responsibility for all functions within provider compliance and education dedicated to capitated/delegated IPAs and medical groups. Managed annual internal annual budget of $3 million. Created and enforced corrective actions for non-compliant providers. Created and served as Chair of FH Corporate Provider Compliance Committee Vice President, Provider Services Director, Provider Relations Managed contractual relationships with provider networks and directed all activities in provider relations, provider inquiries, and provider education functions for commercial HMO, PPO and TriCare lines of business. Directed annual internal operating budget of $4 million and staff of 80 FTEs. 1992 to 1995

Blue Cross & Blue Shield of Ohio Corporate Director of Provider Relations/Manager of Program Development

Toledo, Ohio 1979 to 1992

Implemented "best practices" procedures for the resolution of provider inquiries regarding benefit programs, contract terms, and/or claims payments. Served as project manager and led task force to implement new hospital payment mechanisms and employer group benefit programs. Designed and implemented utilization management programs including pre-certification, concurrent review, retrospective review and second surgical opinions.

Education and Professional Affiliations

Bachelor of Science in Education, Bowling Green State University, Bowling Green, Ohio, 1975. Graduated with Honors (Cum Laude). Member Phi Alpha Theta Honorary Society Earned Certified Health Consultant designation from Krannert Graduate School of Business, Purdue University/Blue Cross and Blue Shield Association with examination scores in top ten nationally. Member HCFA/CMS Region IX Claims Audit Task Force Appointed to Ohio Governors Task Force on Diabetes Education Licensed California Health and Life Insurance Broker, license number OC36581 Currently pursuing Certified Employee Benefit Specialist (CEBS) designation