Sean Burns Email & Phone Number

Westbury, New York, United States

Greater Minneapolis-St. Paul Area

Directed division of over 200 network professionals across country, with executive leadership over strategy and management of Carelon Behavioral Health provider network. Maintained a national network of providers across commercial, Medicare, and Medicaid lines of business. Functions included: Strategy and Innovations, Provider Experience, Provider Contracting, Network Support, Network Analytics, and general accountability for provider operations. Executed network expansion to enhance availability of providers in new markets, and grew value base contracting across the entire footprint for behavioral health. Provided thought leadership supporting growth and retention of over 250 clients.• Restructured the provider network management team to better align with the business needs, focusing on provider value, experience, and access• Led the network expansion in many states to support existing client growth, and new client needs.• Deployed a value based strategic framework to drive new innovation in behavioral health • Served as primary stakeholder in business development initiatives to drive and enhance partnerships, leading the investment in provider relationships.• Executed many national provider contracts for new innovated provider organizations, and to help expand access in key service areas.• Led integration of Elevance behavioral health provider network in partnership with stakeholders across Elevance enterprise.• Developed new capabilities to deliver value access and provide better experience nationally.• Partnered with Elevance and Carelon’s growth teams to retain and grow client base, participating in many existing and prospective client discussions.

Greater Pittsburgh Area

Led division of professionals across Highmark footprint (PA, WV, DE, WNY) as executive leader of multi-year strategic roadmap of value-based programs, including creation of value proposition, support capabilities, and technical infrastructure to deliver implementation. Served as executive leader for fee-for-service reimbursement model and reimbursement policy across all lines of business and sites of care. Led the business development of all provider network development strategies, and owner of all healthcare provider operational functions, including credentialing, provider demographic, fee for service, and value-based reimbursement management and implementation. Developed and implemented new care models and other population health strategies through provider-owned assets.• Worked as executive leader of strategic roadmap for narrow, tiered, centers of excellence, and all other network development strategies.• Contributed as executive representative to Blue Cross and Blue Shield Association: Blue Distinction Total Care Executive, High-Performing Network Executive, and Blue Distinction Center of Excellence.• Collaborated with Pennsylvania, Delaware, West Virginia, and New York legislators to shape healthcare policy across those states.• Developed and implemented high performing networks across the Highmark footprint.• Owned key adjudication platforms that supported provider network functions. • Represented Highmark on Pennsylvania Rural Health Redesign Organization.

Greater Minneapolis-St. Paul Area

Built and led strategy consulting practice within payer consulting organization, focusing on local / national payers and large provider systems around healthcare innovation strategies. Led business development, growth, and program execution partnering across practice. Partnered with various business units throughout UnitedHealth Group for both intracompany and commercial engagements.• Grew revenue from zero to multi-million dollars in the first year, closing many consulting engagements.• Led many consulting engagements that focused on network management innovations and standard process improvement programs to help gain efficiencies.• Supported a national rollout of value based contracting for a large national payer organization.• Collaborated with Optum’s product teams to leverage point solutions to identify both growth and consulting engagement opportunities.• Built new health plan focused on individual insurance, expansion of value-based programs across UHC, administrative simplification programs, technology upgrades, and risk adjustment and Stars.

Greater Minneapolis-St. Paul Area

Served as owner of ICD-10 program represented by large matrix organization with annual budget of over $60M and over 100 individuals throughout duration of projects. Prepared organization for healthcare reform, including leading integration with Minnesota state-based exchange.• Collaborated across enterprise to ensure all requirements were met.• Worked with State of Minnesota to integrate with their state-based healthcare exchange.• Partnered across Blue’s system for both ICD-10 and healthcare reform to drive consistency.

Greater Minneapolis-St. Paul Area

Directed department of 40 business professionals with key accountabilities of development of value-based payment models, population health analytics, modeling and negotiating of provider contracts, reimbursement policy, provider settlements, interplan access fee management, and administrative simplification initiatives. Partnered with actuarial teams to establish rating trends with legislative affairs to influence local and federal to influence regulatory process. Partnered with various Blue plans on various initiatives.

Greater Minneapolis-St. Paul Area

Led team of ten business professionals focused on creation of implementation of fee-for-service structures, negotiating financial provisions and managing provider settlements.

Greater Minneapolis-St. Paul Area

Developed negotiation strategies and modeled healthcare provider contracts. Managed procurement process for IT purchases.

Greater Minneapolis-St. Paul Area

Provided support to financial planning and analysis, annual budgeting process, and month-end close. Supported negotiating of fees for non-proprietary fund partners.

Master Of Business Administration (Mba), Business Administration And Management, General

Bachelor Of Business Administration (Bba), Accounting And Finance