David Adams Healthcare Operations Executive

Healthcare Operations Executive

HealthCare

May 2026 - Current (4 months)

CEO of Health Plans (through April 2026)

Ramona

Aug 2025 - Apr 2026 (9 months)

Ramona Health is a med-tech start-up utilizing advanced AI to drive patient outcomes and reduce costs. ● Market Expansion: Recruited as senior executive to establish and build Medicare Advantage and C-SNP plans across Kansas, Missouri, Arkansas, and Oklahoma. ● Strategic Architecture: Spearheaded initial market entry and expansion strategy utilizing creative, AI-driven solutions for patient outcomes and cost reduction. ● Executive Leadership: Maintained excellent personal performance metrics through extreme industry volatility caused by shifting CMS rate releases.

CEO of Health Plans

Ramona

Aug 2025 - Apr 2026 (9 months)

Ramona Health is a med-tech start-up utilizing advanced AI to drive patient outcomes and reduce costs. ● Market Expansion: Recruited as senior executive to establish and build Medicare Advantage and C-SNP plans across Kansas, Missouri, Arkansas, and Oklahoma. ● Strategic Architecture: Spearheaded initial market entry and expansion strategy utilizing creative, AI-driven solutions for patient outcomes and cost reduction. ● Executive Leadership: Maintained excellent personal performance metrics through extreme industry volatility caused by shifting CMS rate releases.

Chief Operating Officer

Molina Healthcare of New Mexico

Sep 2023 - May 2025 (1 year 9 months)

Executive accountable for comprehensive health plan operations, including Claims, Compliance, Network, and IT Oversight. ● Rapid Stabilization: Oversaw operations for four major markets (IL, MI, SC, WI), bringing all into "green" status for operational KPIs within five months. ● TPA Oversight & Operational Risk Mitigation: Led the transition of all claims processing to FirstSource; successfully migrated 400 examiners and achieved operational stability in three months—beating the nine-month projection by 200% while mitigating significant implementation risks. ● Market Turnaround: Stepped in as COO/CIO for the NM health plan to salvage a challenging Medicaid contract implementation, achieving long-term stability milestones within fo

Director of Claims and Configuration

Centene Corporation

Jun 2018 - Sep 2023 (5 years 4 months)

Managed local MCO operations for one of the nation’s leading Medicaid and Medicare payers. ● System Implementation: Successfully directed the implementation of claims systems for NM Medicaid, serving 90,000 members. ● Performance Excellence: Consistently maintained an auto-adjudication rate exceeding 90%. ● Crisis Leadership: Leveraged creative solutions to lead a seamless 100% transition to remote work during COVID-19 while reducing claims turnaround time by approximately 50%. ● Claims Governance & Regulator-Sensitive Environment Management: Served as the designated Claims Administrator, maintaining high-level relationships with state regulators and Tribal/IHS stakeholders while ensuring strict adherence to governance standards

David Adams

About

Detail

Timeline

Résumé