Nancy L. Chapa

About Nancy L. Chapa

With extensive experience across healthcare management, I currently serve as Vice President of Payer Contracting at Optum. My focus is on designing and executing innovative risk transfer strategies and commercial network contracts that align with organizational goals to deliver sustainable, high-quality care. I am motivated by opportunities to collaborate with cross-functional teams to cultivate solutions that drive value-based care while ensuring operational excellence. At Optum, I lead the development and implementation of comprehensive risk contracts, including professional and global risk models, while overseeing clinical and administrative functions such as claims, network management, and medical management. My expertise in strategic planning and network optimization enables me to build high-performing networks that meet compliance requirements and improve population health outcomes.

Experience

1. VP Risk Transformation

   Optum

   May 2022 — Present · NM, US

   Responsible for the development of the commercial risk transfer a strategy Crossing Optum Care mountain west region in conjunction with senior regional leader ship team and subsequent execution of the strategy. Responsible for the development in execution of always transfer contacts from models including fall risk professional risk (either pmpm or pop) acute facility gain shares, global risk agreements with combined delegation of health plan clinical and administrative functions including medical management, claims, credentialing and network management for both commercial plans and self funded employer plans. Responsible for the design and contracting of high performing commercial networks which meet network adequacy requirements and achieve overall quality in affordability goals for the organization.

Skills

• Healthcare Consulting
• Claim Investigation
• Behavioral Interviewing
• Icd-10
• Physician Relations
• New Mexico Medicaid
• Revenue Cycle
• Business Process Improvement
• Healthcare Industry
• Project
• Behavioral Health
• Training
• Hipaa
• Change Management
• Analysis
• Medicaid
• Disease Management
• Ncqa
• Icd-9
• Microsoft Office
• Hedis
• Healthcare Reimbursement
• Strategic Planning
• Healthcare Information Technology
• Managed Care
• Claims Management
• Claims Resolution
• Management
• Medical Billing
• Healthcare Management
• Medical Terminology
• Project Management
• Leadership