Experience

Gold Kidney Health Plan

• United States
• Insurance
• 1 - 100 Employee

• Chief Operating Officer

  • May 2023 - Present

  Gold Kidney Health Plan is a Medicare Advantage Plan offering Medicare Advantage products for beneficiaries with Chronic Special Needs. As Chief Operating Officer, I will assume responsibility for leading all of Gold Kidney's activities including sales, operations, stars, network including VBC contracting and Medicare products. I will report to the Chief Executive Officer Dave Firdaus and act as a strategic partner to the Board of Directors and private equity sponsor to support the company's growth objectives. I also will serve as a key member of the senior management team and will be a leader in driving growth and transformation for the company. Gold Kidney Health Plan is a Medicare Advantage Plan offering Medicare Advantage products for beneficiaries with Chronic Special Needs. Gold Kidney currently holds an insurance license in Arizona and a Medicare contract from CMS (Center for Medicare Medicaid Services). Gold Kidney's patient-centric care approach integrates payor, provider, and care management technology to effectively improve patient outcomes and quality. At Gold Kidney, the patient's well-being is our number one focus and priority. To learn more, visit www.goldkidney.com. Show less



GK Healthcare Consulting Group LLC

• GK Healthcare Consulting Group LLC President & CEO

  • Jun 2022 - May 2023

  Overview: GK Healthcare Consulting Group is the leader in strategic consulting and specialized business Health Care solutions for government-sponsored programs. The Company was founded by Gregg Kunemund in 2022 who has a 39-year history as a thought leader and expert advisor to government-sponsored health plans, with a particular focus on Medicare Advantage. The Company’s experts consist of managed care veterans who have served at every decision-making level of leading plans, PBMs, and state and federal agencies. The Company also offers a set of specialized and innovative technology solutions that solve problems not typically addressed by enterprise systems. Areas of Focus • 2022 Risk Adjustment Strategy and Program Readiness • Star Ratings & HEDIS collection expertise • Health Systems Value Based Contracting strategies • ACO Shared Savings expertise & Guidance • Clinical program support for Value Based Care • Medicare & Medicaid Sales & Growth • Medicare Advantage Products such as Dual Eligible Plans DSNP, Chronic Plans CSNP, Individual Community Plans, Group Retire EGWP, Part D stand-alone • Medicare Operations Consumer Assessment of Healthcare Providers & Systems (CAHPS) & Health Outcome Surveys (HOS) • Private Equity & Hedge Fund Consulting for investments firms looking for Healthcare trends and insights Show less



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Health Plan Chief Executive Officer (CEO) Medicare & Retirement

  • Jan 2010 - Jun 2022

  As the Local Market CEO accountable for achieving profit and loss targets (overseeing 4.5 billion in revenue) sales, network, market expansions, product designs and operations oversight for the Medicare Advantage, Part D and Medicare Supplement portfolio of products in Alabama, Georgia, Louisiana, Arkansas, Tennessee & Mississippi. Responsible for developing and deploying business plans at the market level with a strong focus on Stars programs, managing clinical and network costs and building relationships across the markets key stakeholders; regulatory, provider, claims, service operations, medical management, community partners. As the Local Market Executive, develop collaborative relationships with central service leaders to target local strategies such as; network composition, product mix/benefits, marketing campaigns, and membership retention programs, with the end result being optimal competitiveness- balanced with enterprise effectiveness. Responsibility for strategy, growth, process improvement, policy development, program planning, profit and loss management, administration and operation of assigned plan functions, programs and activities. MLR accountability is primarily focused on revenue improvement (via RAF/Coding Accuracy, STAR ratings) and medical cost management Market Quality Leader directing team success, and moving STARs improvement from 2.5 to 4 STARs in over 89% of my 766,000 Medicare membership, and building team strategies to drive to 5 STARs. Oversee 122 ACO network gain-share and risk capitation deals & NPS score 70 combined five states Show less



Florida Blue

• United States
• Insurance
• 700 & Above Employee

• Medicare & Medicaid Product & Operations Leader State of Florida

  • Apr 2004 - Dec 2009

  Manager of Medicare Group Retiree & Individual Products Operations for Florida. Call Center, Products & Appeals and Grievances. Launch new products and expansion of Medicare Part D, Nationwide Medicare Advantage PFFS, Regional PPO, HMO, POS, Employer Group Waiver Plans (EGWP) and Medicare Supplement. Manager of Medicare Group Retiree & Individual Products Operations for Florida. Call Center, Products & Appeals and Grievances. Launch new products and expansion of Medicare Part D, Nationwide Medicare Advantage PFFS, Regional PPO, HMO, POS, Employer Group Waiver Plans (EGWP) and Medicare Supplement.



AvMed

• United States
• Insurance
• 400 - 500 Employee

• Director of Medicare & Medicaid Products & Service Operations

  • Feb 1991 - Feb 2003

  •Direct the medical claims, customer service and enrollment of the Medicare Part A & B and Medicaid member service call center, claims and enrollment departments consisting of 2 managers 3 supervisors and a total of 100+ employees. •Develop and implement performance standards for the Department. Hire, coach, mentor and lead staff to reach department goals. •Filed market expansions with CMS and Medicaid benefits with OIR •Handle 45,000 service calls, process 160,000 claims and 750 appeals on a monthly basis. •Chair various CMS workgroups. Show less