Derek L. Email & Phone Number

Greater Seattle Area

- CFO for Medicare lines of business with full P&L accountability.- Currently leading the financial turnaround of recently integrated CA Medicare plan, Bright Health.- M&A Medicare SME leading due diligence and modeling for potential new business.- Implementation of standard UM/CM benchmarks to increase productivity and drive performance improvements.- Development and renegotiation of actuarially sound full risk IPA capitation deals.- Reduction of opex by 20% through identification of wasteful third-party contracts.- Received the highest 2021, 2022, and 2023 employee engagement scores within the Molina finance group.

Greater Seattle Area

- Led the implementation/start-up of a new managed care offering in KY; built the team and processes from the ground up.- Engineered a $200M (10% pre-tax) turnaround using novel FOIA data requests to benchmark against competitors.- Formulated/implemented a list of savings initiatives focused on UM, Payment Integrity, config, and re-contracting.- Built an in-house, automated provider scorecard focusing on MLR improvement areas and targeted Quality metrics.

Greater Seattle Area

- M&A due diligence, pro forma modeling, and financial oversight for the acquisition of a $2B health plan.- Directed the integration of claims data into Molina’s systems; led final purchase accounting to complete the transaction.- Drove $40M of accretive value through vendor and FTE synergy projects.- Cash flow management resulted in $250M of additional funds available for investment in higher interest rate environment.

Greater Seattle Area

- Led the strategy, FP&A, actuarial, contracting, accounting, analytics, and M&A finance for three value based care service lines totaling $2B in revenue for the largest private equity funded hospitalist staffing company in the country.- Built the teams, structures, processes, reporting, metrics, and program offerings supporting these VBC service lines.- BPCIA (CMS bundled payments) subject matter expert charged with analyzing and negotiating gain-share partner deals.- Maximized at-risk revenue via improving next site of care utilization, readmissions, and SNF length of stay.- Developed value propositions and cost reduction offerings using managed care interventions to grow these new service lines.- Partnered with clinical teams to create an HCC risk adjustment code capture program that added $15M in new value.

Des Moines, Iowa Area

- Led the implementation of a 350k member, $3B managed care plan with LTSS, Dual, ABD, CHIP, TANF, and MA products.- Built the finance, analytics, claims, and network departments while developing external and internal reporting from scratch.- Project managed the go-live for PDM, claims configuration, the provider network, 820/834 files, and other IT/ops functions.- Lead rate negotiator who secured an 8.6% base rate increase, up from the Iowa DOI proposed 1.7% increase.- Oversaw facility acquisition & expansion, lease negotiation, and office management/planning functions.

Greater Seattle Area

- P&L responsibility for a 270k member, $1B multi-product division within Centene.- Principal driver of MLR improvement initiatives centering around UM, CM, PI, FWA, and re-contracting.- Built a UM productivity model that resulted in $13M/year in savings.- Developed an at-risk VBC focused on increasing HEDIS, closing risk gaps, growing membership, and advancing P4P/VBP.

Greater Seattle Area

- Led rate negotiations – developed a duration model that convinced the state to increase Expansion rates by 4.5%.- Formulated, implemented, and ran the membership growth & re-enrollment program.- Partnered with corporate controller to provide compliance oversight, ensure financial transparency, and assist with auditing.

Greater Seattle Area

- Built an in-house risk adjustment team to boost both Medicaid and Marketplace revenue.- Implemented a home-grown outbound call campaign, coordinated in-home assessments, integrated the case management department, developed provider education presentations, and oversaw the chart chase activities.- Developed novel productivity measures & benchmarks to track & monitor both project and employee performance.

Greater Seattle Area

- Led the budget process; redesigned the forecasting models which resulted in increased accuracy.- Drove month end close, set reserves, created ad-hoc reports/presentations, and presented results to executives.

Portland, Oregon Area

- Developed rates and pricing for over 50k products and services within a $3B organization.

Portland, Oregon Area

- Prepared Medicare/Medicaid cost reports and analyzed payer mix trends for a multi-facility DSH and GME organization.

Master Of Business Administration (Mba)

Activities and Societies: Beta Gamma Sigma

Bachelor Of Science (B.S.), Finance