Health Management Associates
Costa Mesa, CA
Sheila Wilson is a registered nurse with over 35 years of experience in both the clinical and managed care environments. For more than two decades she has excelled at leading care management teams crossing multiple lines of business, including small and large group commercial, the individual product, Medicare Advantage, and D-SNP with a primary focus on the Medicaid population.
With Health Management Associates, Sheila will be writing requests for proposals, focusing on care management and utilization management. She will be facilitating community and health plan collaborations as well as working on system integration and local and state program development, implementation and evaluation. Sheila also has a strong interest in the Justice Involved Space and will be pursuing opportunities within this focus area.
Before joining HMA, Sheila served as the senior director of care management at Priority Health, Inc. in Michigan. In this role, she was responsible for the development, implementation, and administration of programs to improve the member care experience and health outcomes for the Medicaid, individual and D-SNP populations while meeting medical business unit cost goals. She led a team of nearly 300 care management staff, including registered nurses, licensed master social workers, medical care coordinators, community health workers and program specialists. Sheila was frequently chosen to lead special projects, assume interim leadership roles in other departments, and serve as a featured speaker at national conferences, sharing her care management expertise internally with Priority Health and Spectrum Health as well as externally with State leaders.
Sheila launched the D-SNP product for Priority health in 2020, helping to design, implement and evaluate the product’s model of care. Enrollment reached over 1,100 members in the first month and over 3,000 in the first year, far surpassing their expected 400 members and almost tripling the size of Priority Health’s care management team.
Prior to Priority Health, Sheila served as director of care management at CareSource Ohio, where she oversaw the development and implementation of programs that measurably improved health outcomes while decreasing the overall cost of care for the at-risk Covered Families and Children (CFC) population in northern Ohio.
Sheila earned a Master of Business Administration from Grand Valley State University after being selected along with 20 other Spectrum Health System employees in the second cohort to be put through the collaborative program. She earned her Bachelor of Science in Nursing from Alverno College. She received her certification in case management from the Commission for Case Manager Certification and has held her certification for two decades.
When she is not at work, Sheila is enjoying the California weather, having relocated with her husband after living in the Midwest her entire life. She loves spending time with her four children and eight grandchildren, traveling, seeing new places and meeting new people. She also enjoys reading, crocheting, riding her electric bike and staying up to date on the latest political events.