Dr. Thomas D. Nelson, DO is a physician executive with fifteen years of administrative experience in five insurance organizations, and seven years as the Chief Medical Officer of a large regional hospital network. He possesses extensive knowledge of managed care, health plan and hospital administration. He has been a primary care doctor for over twenty years in family and internal medicine. Dr. Nelson attended the Kansas City University of Medicine, interned in Fort Worth, and did residency in internal medicine in Phoenix, AZ. He is certified by the American Osteopathic Board of Family Practice, the American Board of Quality Assurance and Utilization Review Physicians, the American Board of Utilization Review, and is a candidate for certification by the American College of Physician Executives.
Dr. Nelson is also a consultant for the Health and Human Services Commission for the state of Texas for quality and utilization.
Utilization Management:
Prior Authorization
Concurrent Review
Case Management
Disease Management
Quality Management
Claims & Coding
Pharmacy
Credentialing
Regulatory Compliance
Network Development
Provider Contracting
NCQA & Joint Commission
Graduate Medical Education
ACHIEVEMENTS:
Utilization Management –
Reduced Length of Stay by one day and medical cost by 8% - 12% in two insurance organizations and one hospital organization.
Government Programs
– Twice obtained a state Medicaid insurance contract and instituted the Utilization Management, Quality Management, Provider Network and Credentials Departments.
Credentialing
– Reduced the time for initial credentialing from 120 days to 30 days. Cleared a two-year backlog of re-credentialing and brought it current to every 30 days.
Disease Management
- Organized disease management programs in high-risk pregnancy, diabetes, chronic lung disease and congestive heart failure in health plan and hospital.
Certification & Accreditation
– Successful Joint Commission and NCQA surveys of utilization, quality and credentialing in Health Plan and Hospital. Converted an unsatisfactory-rated ACGME residency program to five-year full accreditation.
EMPLOYMENT HISTORY:
May 2010 – present
Genesis Physician Group
Medical Director 1400 member physician group, Dallas TX
Medical Director, Dallas TX
Quality Review Consultant / Contractor Texas Medicaid
Aug 2008 – present
Clinical Medicine
Apr 2007 – Jul 2008
Molina Healthcare –
Medical Director
175,000 member Medicaid HMO
2005 – 2007
Blue Shield of California –
Medical Director 3-million member PPO - 2007
Coventry / First Health Services –
Contract RFP responses - 2006-2007
Joint Commission (JCAHO)
Physician Surveyor - 2005-2006
– Consultant / Contractor
Physician House Calls –
1998 – 2005
CMO Vice President Medical Affairs
JPS Hospital Network & Metro West Health Plan, Fort Worth, TX
450 bed acute-care hospital; 22 clinic network; staff-model HMO;
150 member physician group.
Regional Medical Director, North Texas
Exclusive Healthcare HMO / Mutual of Omaha, Dallas, TX
100,000 member commercial HMO
1995 – 1997
Vice President, CMO
Harris Methodist Health Plan, Fort Worth, TX
340,000 member commercial, Medicare and Medicaid HMO.
[Acquired by Pacificare of Texas and moved to San Antonio, TX in 1998]
1984 – 1995
Irving and Hurst, TX
1984 – 1988
Blue Cross Blue Shield and Texas Medical Foundation
Physician Reviewer and Appeals Officer, Texas Medicare PRO
1982 – 1984
Emergency Services, Port Arthur (Groves), TX
1981 – 1982
Phoenix General Hospital, AZ
1974 – 1981
Fort Worth, TX
BUSINESS / MEDICAL EDUCATION:
MBA,
American College of Physician Executives (ACPE)
in progress
Residency
Internal Medicine, Phoenix General Hospital, Phoenix, AZ
1981 - 1982
Internship,
Osteopathic Medical Center of Texas, Fort Worth, TX
1973 - 1974
DO,
Doctor of Osteopathic Medicine, Kansas City University of Medicine 1969 -
1973
BA,
Bachelor of Arts in Science, Youngstown State University, Youngstown, OH
1965 - 1969
Clinical Medical Practice – Internal Medicine Residency
Doctors Hospital, Clinical Medical Practice –
Texas, Tennessee (active)
Missouri, Arizona (inactive)
PROFESSIONAL MEMBERSHIPS:
American Osteopathic Association (AOA)
American College of (Osteopathic) Family Practice (ACOFP)
American College of Physician Executives (ACPE)
American Board of Quality Assurance & Utilization Physicians (ABQAURP)
