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Sheila H. Nelson

Sheila Nelson Picture

Sheila H. Nelson

Senior Vice President,
State Programs

Sheila H. Nelson joined CDPHP in 2010 and currently serves as senior vice president, state programs. She is responsible for overall performance, operations and compliance for the state programs portfolio, which currently comprises more than 95,000 members in the Medicaid, HARP, and Child Health Plus programs. Sheila’s operations responsibilities include enrollment, billing, and delegated dental benefit management. As it relates to compliance, Sheila directs plan oversight of program-specific audits by the Office of Medicaid Inspector General and NYS Department of Health (DOH), as well as the DOH audits of the plan’s compliance with the requirements the state’s key managed care laws. Her team also directs internal compliance with New York’s requirements for independent dispute resolution for certain out-of-network claims.

Prior to joining CDPHP, Sheila held various health care policy positions in the Capital Region, including having served for 14 years as vice president, public policy and regulatory affairs, at the New York Health Plan Association. Sheila holds a Master of Health Administration from Cornell University and a bachelor’s degree in psychology from Union College.