Diane Gilworth, APRN, MPH

Diane Gilworth is an accomplished and strategic healthcare executive and advisor with clinical and executive leadership experience in provider, payor and vendor organizations. Diane has a deep understanding of clinical care after decades of practice as a Nurse Practitioner and a critical care nurse. As a senior leader in national and local managed care organizations (“MCOs”), she leads the clinical business strategy for medical loss ratio (“MLR”), management with oversight responsibility for physical and behavioral healthcare management, utilization management, appeals and grievance, and quality and pharmacy in ambulatory, hospital, post-acute skilled nursing facility (“SNF”) and PAC-BH and home care sites of service. Diane has a successful record of improving patient and member outcomes, while lowering cost and balancing patient, provider, payer experience and regulatory requirements.

Diane served as Senior Vice President of Point32Health, serving 1.2 million members through Medicare, Medicaid, MCO and accountable care organizations (“ACO”), Duals Programs, One Care and Senior Care options, Qualified Health Plan (“QHP”) and Commercial lines of business. She led the Dual-Eligible Special Needs Plan (“DNSP”) to a 4-STAR rating for the first year of eligible performance and led the in-sourcing of behavioral health services for the commercial plan while overseeing the in-home care management and collaboration with community behavioral health centers for the Affordable Care Act (“ACA”), State and Federal Medicaid Program. She was instrumental in the National Committee for Quality Assurance (“NCQA”) Health Equity accreditation for 2023.

As Chief Clinical Officer at WellSense (formerly Boston Medical Center Health Plan), Diane held responsibility for the strategy, supervision and management of comprehensive physical and behavioral health care management to more than 325,000 members in Massachusetts, as well as 90,000 members in New Hampshire, ensuring oversight and strategic direction for Medicaid, QHP and the development of a Medicare Plan in New Hampshire.

As Senior Vice President Highmark Health, Diane directed the healthcare services to optimize value-based care; she reported to the health plan CEO and corporate Chief Medical Officer (“CMO”). In this role, she also led a 900-person staff across diverse functional areas, including care management, utilization management, pharmacy, behavioral health and wellness, while developing standards of care for AHN practices during the development of an integrated delivery and finance system between HIGHMARK and the provider group, AHN.

As Executive Director of Clinical Operations and Chief Nursing Officer for Aetna Medicaid in Phoenix, Diane orchestrated the enhancement of clinical service offerings supporting individual state-based Medicaid Plans covering 3 million Medicaid lives, including Temporary Assistance for Needy Families (“TANF”), Children’s Health Insurance Program (“CHIP”), Long-Term Services and Supports (“LTSS”), Aged, Blind or Disabled (“ABD”), Developmental Disability (“DD”), ACA, DSNP, Medicare-Medicaid Plan (“MMP”) and dual-eligible populations. She reported to the CMO and led a team of 200 to employ a data-centric approach for formulation of fully integrated systems in 17 state Medicaid plans, including care management and integrated behavioral health, working directly with community mental health centers, as well as request for proposal (“RFP”) development for 17 states and clinical platform integration within each state and associated community network.