Sean Burns Email and Phone Number
As an innovative and results-driven senior healthcare executive, I am passionate about driving change, creating value, and delivering exceptional outcomes. With a successful record of accomplishment in change management, business development, and strategic planning, I have consistently redefined expectations and developed high-performing teams. My guiding principle is to always prioritize the needs of both internal and external stakeholders, ensuring that their goals align with the organization's vision. With extensive experience in organizational development, policy development, and continuous improvement, I bring a unique set of knowledge and expertise to the table. I have led the restructuring and turnaround of multiple regional and national business units, as well as the integrating provider network functions across a number of different organizations that I supported. Additionally, I have successfully managed complex system implementations and migrations, generating operational efficiency and achieving compliance. Throughout my career, I have achieved numerous career highlights and received recognition for my contributions. I have played a key role in the creation of multi-year roadmaps that have resulted in significant financial gains, exceeding $200M and growing. I have also served as a board representative for various organizations, supporting strategic investments and fostering key relationships. Furthermore, I have built a consulting practice from the ground up, delivering multi-million dollars in revenue and driving payment innovation. Looking ahead, my goal is to continue making a difference in the healthcare industry. I am committed to leveraging my expertise to improve patient outcomes, drive operational excellence, and support the growth and success of healthcare organizations. Whether it be through advising on network management, leading change initiatives, or shaping healthcare policy, I am dedicated to contributing to the advancement of the industry. I invite you to connect with me to explore how we can collaborate and create meaningful impact together. Let's work towards a future where healthcare is accessible, efficient, and patient-centered.
Brighton Health Plan Solutions
View- Website:
- brightonhps.com
- Employees:
- 87
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Svp Network Strategy And ContractingBrighton Health Plan Solutions 2024 - PresentWestbury, New York, United States
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Vice President- Chief Network OfficerCarelon Behavioral Health 2022 - 2023Greater Minneapolis-St. Paul AreaDirected 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. -
Vice President Provider Payment And Network Infrastructure, Highmark BcbsHighmark Health 2015 - 2022Greater Pittsburgh AreaLed 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. -
Vice President Network Management And Payment InnovationsOptum 2014 - 2015Greater Minneapolis-St. Paul AreaBuilt 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. -
Senior Director - Icd-10, Exchange, And Special ProjectsBlue Cross And Blue Shield Of Minnesota 2012 - 2014Greater Minneapolis-St. Paul AreaServed 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. -
Director - Network & Health Management FinanceBlue Cross Blue Shield Of Minnesota 2008 - 2012Greater Minneapolis-St. Paul AreaDirected 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.
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Manager - Payment Methodology, Provider Pricing And Healthcare CodingBlue Cross And Blue Shield Of Minnesota 2005 - 2008Greater Minneapolis-St. Paul AreaLed team of ten business professionals focused on creation of implementation of fee-for-service structures, negotiating financial provisions and managing provider settlements.
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Senior Financial AnalystBlue Cross And Blue Shield Of Minnesota 2002 - 2005Greater Minneapolis-St. Paul AreaDeveloped negotiation strategies and modeled healthcare provider contracts. Managed procurement process for IT purchases.
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Various Financial Analyst PositionsAmeriprise Financial Services, Llc 1996 - 2002Greater Minneapolis-St. Paul AreaProvided support to financial planning and analysis, annual budgeting process, and month-end close. Supported negotiating of fees for non-proprietary fund partners.
Sean Burns Education Details
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Business Administration And Management, General -
Accounting And Finance
Frequently Asked Questions about Sean Burns
What company does Sean Burns work for?
Sean Burns works for Brighton Health Plan Solutions
What is Sean Burns's role at the current company?
Sean Burns's current role is Innovative and Results-Driven Senior Healthcare Executive | Change Management | Organizational Development | Strategic Planning | Value Creation.
What schools did Sean Burns attend?
Sean Burns attended University Of St. Thomas, University Of Wisconsin-Oshkosh.
Who are Sean Burns's colleagues?
Sean Burns's colleagues are Preyal S., Dina Jordan, Andrea Johnson, Irene Ferrer, Lauren V. Snell, Ashlyn Caloca, Cassidy Mura.
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