Charles Baker

Charles has extensive experience in leading large-scale compliance and operational transformation initiatives across commercial, Medicare Advantage, and Medicaid organizations. His expertise includes directing readiness reviews, developing regulatory response frameworks, and supporting organizations through major state and federal oversight processes. Charles is recognized for translating regulatory requirements into practical operating models that enhance compliance, operational performance, member experience, and clinical quality.

Health Plan Engagements

Charles has led comprehensive compliance assessments and program implementations for regional and national health plans. His contributions include:

• Developing and executing compliance review methodologies covering utilization management, grievances and appeals, quality programs, and member operations.
• Building monitoring frameworks and corrective action structures to prepare for federal and state audits.
• Guiding organizations through membership expansions, new product offerings, and regulatory transitions.
• Designing tools and workflows to strengthen accountability, improve documentation quality, and enhance audit defensibility.
• Advising leadership teams on oversight models for vendors, clinical partners, and delegated entities, including governance, reporting, and escalation pathways.

Regulatory Transformation and Operational Improvement

Charles has supported organizations through significant operational shifts driven by policy changes, program modernization, and new regulatory requirements. His work includes:

• Developing business requirements and implementation plans for regulatory changes affecting enrollment, appeals, supplemental benefits, and care coordination.
• Creating cross-functional operating models that integrate compliance, clinical operations, information technology, and member-facing functions.
• Implementing performance measurement frameworks linking regulatory expectations to workflow execution, quality outcomes, and risk mitigation.

Provider and Clinical Operations Leadership

Before his advisory roles, Charles held leadership positions across health systems and community-based organizations, overseeing clinical and operational teams, developing new service lines, and optimizing care delivery models. His achievements include:

• Directing neurorehabilitation and behavioral health operations across multiple sites, supervising large clinical teams, and improving documentation, billing accuracy, and staffing efficiency.
• Implementing neurological and rehabilitation programs system-wide, including tele-neurology expansion and new hospitalist models.
• Managing federally qualified health center operations, ensuring compliance with Health Resources and Services Administration requirements, grant obligations, and care-quality standards.
• Leading mental health operations across multiple sites, enhancing clinical documentation compliance, audit performance, and addressing billing and coding gaps.