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| As a Vice President of Managed Care Resources, Paula Nelson provides client assistance in the areas of network development, including the negotiation of payer/provider agreements, organization design and operations management. Paula has worked over 20 years in health care management with extensive experience both on the provider and payer sides. |
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In her role as Finance Manager for a community health center, Paula assured the successful start up and growth of this multi-specialty practice and administered its first managed care contract. She has since managed ambulatory care operations for a multi-specialty practice with significant HMO enrollment and later for the largest Staff Model HMO in the Chicago Metropolitan area. She concentrated on improvements to operational systems resulting in more cost-effective, customer-oriented service delivery within a managed care environment. Her accomplishments with the HMO organization also include the establishment of a property management division that identified facility maintenance and design specifications, performed project management and lease/facility contract negotiation services during a significant growth phase.
More recently, Paula has directed the Ancillary Provider Network for a 440,000 member Managed Care Organization serving a three state region. In this capacity, she was responsible for organizing and developing a network serving both Staff and IPA-Model HMO, PPO, POS and ASO memberships, including Medicare and Medicaid plans. She has negotiated various types of contracts valued over $30 million annually. She is familiar with various reimbursement methodologies and has contracted numerous capitation and other risk sharing arrangements. Under her direction, credentialing standards and provider relations policies and procedural guidelines were established. Paula has successfully collaborated with providers and clinical and utilization managers on the analysis, pricing and implementation of disease state management and other innovative service delivery programs.
Paula holds a B.A. from Lake Forest College, an honorary degree from the Instituto de Cultura Hispanica in Madrid, Spain and a M.B.A. from the Keller Graduate School of Management in Chicago.
Paula Nelson can be reached at pnelson@mcres.com.
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