June 1, 2023

Karen Carlson of Rehoboth Named Chief Operating Officer at Neighborhood Health Plan of Rhode Island


July 13, 2022 (Smithfield, RI) – Neighborhood Health Plan of Rhode Island (Neighborhood), a not-for-profit health plan founded to serve Rhode Island’s at-risk populations, is excited to announce a new member of its executive leadership team. Karen Carlson, chief operating officer.

Karen Carlson
As chief operating officer of Neighborhood, Carlson will apply over 20 years of experience building efficient and effective teams at health and human service organizations to leading the Operations Division at the health insurance plan. Her key responsibilities will include strategic management and performance oversight of business operations across the enterprise, including call center services, claims management and information systems. As a key part of Neighborhood’s executive leadership team, Carlson will also contribute to setting the strategic direction for the organization.

“With half of Karen’s career spent in human services, half in healthcare, and with significant experience building a lean management culture, she is uniquely qualified and an exceptional fit for the Neighborhood team,” said Peter Marino, president and CEO of Neighborhood. “She brings to our organization deep experience in Medicare and Commercial health plans – having overseen enrollment, call centers, claims payment, payment integrity, grievance and appeals processing, and Medicare compliance. Additionally, Karen is skilled in decreasing manual processes and increasing consistency in procedure performance. We are fortunate to have Karen on our executive leadership team and look forward to her contributions to advancing Neighborhood’s mission.”

Carlson most recently served as managing director at Blue Cross and Blue Shield of Rhode Island (Blue Cross). In this role, she was responsible for timeliness, quality, compliance and payment integrity for more than 8.5 million claims payments and 12,000 grievance and appeals cases per year. During her 15 years at Blue Cross, she also held positions as business solutions architect leading large scale initiatives within Client Operations and manager of Technical and Business Analysis directing the research team in resolving medical and pharmacy benefit issues.

Earlier in her career, Carlson advanced through direct care positions at the Walker Home and School and the YWCA of Northern Rhode Island before joining Family Service of Rhode Island. While there, she transitioned from program director responsible for mental health outreach and case management programs to director of Operations overseeing 10 locations and responsible for the bidding processes, contract management and project management.

Karen holds an undergraduate degree from the University of Massachusetts and a Master’s degree from Nova University. She has been Project Management Professional (PMP) certified since 2005. Karen resides in Rehoboth, Mass.

About Neighborhood:

Neighborhood Health Plan of Rhode Island (Neighborhood) is a not-for-profit health maintenance organization (HMO) founded in December 1993 in partnership with Rhode Island’s Community Health Centers and the state to ensure everyone in Rhode Island has access to high quality, cost-effective health care. Neighborhood serves over 221,000 members in the state with 82 percent of its membership Medicaid eligible through its ACCESS and TRUST plans and 6 percent of its membership utilizing Neighborhood’s INTEGRITY Medicare-Medicaid Plan (MMP). About 12 percent of Neighborhood’s members are individuals, families and small businesses who select one of eight Neighborhood commercial plans available through the health exchange, HealthSourceRI. Of these members, about 85 percent qualify for federal subsidies to cover a portion of their costs. Today, Neighborhood—with over 600 employees and $1.5 billion in revenue—serves one out of every five Rhode Islanders. Learn more at www.nhpri.org


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