Open to opportunities

Gerald Kiplinger

@geraldkiplinger

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Accomplished healthcare executive with expertise in Medicaid and managed care.

United States

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What I'm looking for

I am looking for a leadership role that allows me to drive healthcare innovation and improve patient outcomes.

I am an accomplished leader with a Master's degree and extensive experience in Medicaid, managed care, and healthcare operations. My career spans both government and private sectors, where I have successfully led initiatives that enhance healthcare delivery and improve patient outcomes. I am recognized for my strategic and financial planning skills, which have been pivotal in driving business development and program implementation.

Throughout my career, I have held key leadership roles, including Vice President of Market Operations at Evolent Health and Chief Operating Officer at Cook County Health & Hospitals Systems. In these positions, I directed operations for large-scale Medicaid managed care programs, overseeing claims processing, call center operations, and compliance with state contracts. My ability to build strong vendor relationships and manage diverse teams has consistently resulted in exceeding operational milestones and achieving positive clinical outcomes.

With a strong commitment to community resource development and cultural diversity, I strive to create inclusive healthcare environments that cater to the needs of all populations. I am passionate about leveraging my expertise to drive innovation in healthcare delivery and improve access to quality care.

Experience

Work history, roles, and key accomplishments

VP, Market Operations

Evolent Health

Jun 2018 - Mar 2020 (1 year 9 months)

Led operational support for BCBS IL cohorts, overseeing claims, enrollment, call center operations, and provider data management. Implemented Cook Medical Group IPA and managed back-office functions for over 50,000 commercial members.

Call Center Operations Claims Management Provider Management Team Leadership Support Operations Business Development

Chief Operating Officer

Cook County Health & Hospitals Systems

Jan 2013 - Jan 2018 (5 years)

Directed daily operations of a Medicaid managed care program serving over 400,000 enrollees. Managed vendor relationships, claims processing, call center operations, and compliance with state contracts.

Vendor Management Call Center Operations Compliance Care Coordination Team Building Program Management

Vice President, Client Services

HealthHelp

Jul 2012 - May 2013 (10 months)

Managed operations for client relations, provider relations, medical economics, and program quality management. Successfully implemented new client programs and improved performance reporting systems.

Medical Economics Program Management Quality Management performance reporting Operational Management

Chief Operating Officer

UnitedHealth Care

Feb 2009 - Jan 2012 (2 years 11 months)

Oversaw operations for Medicaid managed care and CHIP programs, achieving operational milestones ahead of schedule.

CHIP Programs Strategic Planning Team Leadership

Vice President, Health and Disease Management

APS Healthcare, Inc.

Jul 2004 - May 2009 (4 years 10 months)

Managed strategic development of state government contracts, exceeding enrollment targets and achieving positive clinical outcomes.

Government Contracting Enrollment Strategies Clinical Outcomes Strategic Development

Executive Director

Healthways

Jan 2000 - May 2004 (4 years 4 months)

Directed implementation and management of healthcare services, increasing outpatient revenue.

Healthcare Services Revenue Management Implementation Operational Management Team Leadership Strategic Planning

Healthcare Executive

U.S. Navy, Medical Service Corp

Jan 1990 - Jan 2000 (10 years)

Led implementation of TRICARE program across five states, integrating Military Health System and VA Hospital to improve efficiency and patient satisfaction.

Implementation