Paula Combs Email & Phone Number

United States

Durham, North Carolina

Raleigh-Durham, North Carolina Area

• Partner with enterprise leadership and key stakeholders to identify opportunities and develop business strategies, including creation of business cases, for medical expense reduction initiatives - internal, provider, and vendor solutions. Steward initiatives from assessment through implementation. • Serve as a thought leader and subject matter expert to the organization for health strategies and tactics to impact affordability. • Partner with Enterprise Analytics on the development of an interactive analytics tool to monitor medical expense trend and identify trend drivers with future evolution to include predictive identification of emerging trends.• Partner with Finance and Actuarial Services to reconcile the portfolio of medical expense reduction initiatives to targets in order to maintain affordability and market competitiveness. • Collaborated on the development and activation of a multi-level governance structure and a systematic decision-making framework for the evaluation of potential medical expense reduction initiatives.

Raleigh-Durham, North Carolina Area

• Led the development of a strategic plan for the behavioral health program including a three-year roadmap that outlined integration of behavioral health vendor partners and opportunities to enhance program offerings.• Served as lead on the implementation of an analytics driven program to manage outpatient behavioral health utilization with a focus on appropriateness of care. • Renegotiated contracts with managed behavioral health vendors that resulted in $2.8 million in administrative expense savings.• Led implementation of a new autism benefit for a large self-insured state employee health plan including negotiation of a vendor contract for utilization management services.

Raleigh-Durham, North Carolina Area

• Responsible for the development and implementation of strategic healthcare solutions in collaboration with division and enterprise leadership. • Identified opportunities and developed business strategies that resulted in member health improvements and/or medical expense savings, incorporating input from across the enterprise and external market and through competitive intelligence. • Led the design and development of a specialty pharmacy solution that resulted in $5.5 million annualized medical expense savings. Responsible for development of the request for proposal, evaluation of vendors, and contract development and negotiation. • Led development of the Blue Quality Physician Program for Oncology, the first such program for specialty providers, which provided incentives for quality improvement, cost control, and compliance with oncology pathways.

Raleigh-Durham, North Carolina Area

• Full end-to-end accountability for vendors providing healthcare services, web-based decision support tools, and clinical criteria software. • Responsible for vendor contracting to ensure clear definition of deliverables, proper protections, and alignment with business needs and enterprise goals. • Directed the ongoing management of vendor relationships including enforcement of contract provisions, program governance, issue escalation, and compliance with regulatory and accreditation standards. • Oversight of data management and outcomes measurement including definition of data requirements, validation of program outcomes, and monitoring of performance targets. • Defined and managed financial controls including reconciliation and reporting. Fiscal responsibility for a $25 million annual budget.

• Managed all aspects of assigned disease management programs including management of program budgets and management of relationships with vendor partners. • Established and monitored performance metrics and goals, including process, outcomes, and financial measures. • Led a cross-functional project to implement an innovative pharmacy co-payment reduction for disease management participants which promoted compliance with recommended control medication regimens. • Responsible for clinical outcomes analyses and reporting for NCQA accreditation.

Virginia, United States

• Integrated corporate medical policy standards into business processes at Southeastern subsidiaries. • Developed, implemented, and managed a quality improvement program. • Managed compliance and process improvement initiatives. Implemented process improvements resulting in annual administrative expense savings of $350,000. • Served on a cross-functional business integration strategy team.

Virginia, United States

Virginia, United States

Roanoke, Virginia Area

Blacksburg, Virginia Area

Richlands, Virginia Area

Mba

Bsn, Geriatric Nursing