Job Description
Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.
As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
This is a remote position in which we are able to employ in the following states:Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
- JOB SUMMARY/PURPOSE
- The Director of Provider Contracting is responsible for the strategic leadership, financial oversight, and operational management of the health plan’s Provider Contracting Department within the Finance division of Samaritan Health Plans. This role oversees provider contract development, negotiation, reimbursement methodology design, and contract lifecycle management across all applicable lines of business. The Director will ensurealignment with financial objectives, actuarial assumptions, regulatory requirements, and organizational strategy.
- Our ideal candidate will have the following experience:
- Experience with contract financial forecasts or spend
- Excellent communication skills
- Knowledge of credentialing
- Network adequacy and network management
- Management of staff, budgets, contract negotiations, medicare and/or medicaid contract terms
- EXPERIENCE/EDUCATION/QUALIFICATIONS
- Bachelor's degree or equivalent experience in a related field required. Master's degree preferred.
- Seven (7) years of experience in provider contracting, reimbursement strategy, or healthcare finance, including two (2) years leadership experience, required.
- Experience in reimbursement methodologies, financial modeling, and healthcare regulatory requirements (Medicaid, Medicare Advantage, D-SNP, Commercial) required.
- Experience negotiating with hospitals, physician groups, ancillary providers, and health systems required.
- Experience collaborating with Finance, Actuarial, Legal, and Compliance departments required.
- KNOWLEDGE/SKILLS/ABILITIES
- Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
- Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
- Critical thinking – Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
- Communication and team building – Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
- PHYSICAL DEMANDS
Rarely
(1 - 10% of the time)Occasionally
(11 - 33% of the time)Frequently
(34 - 66% of the time)Continually
(67 – 100% of the time)LIFT (Floor to Waist: 0"-36") 0-20 Lbs
LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 poundsCARRY 2-handed, 0 - 20 pounds
KNEEL (on knees)
BEND FORWARD at waist
CLIMB - STAIRS
STAND
WALK - LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0-20 pounds force)
PULL (0-20 pounds force)
SIT
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
None specified
Numbers & Facts
| Location | Corvallis, OR (Remote) |
Skills
- Budget Managementunmatched
- Communication Skillsunmatched
- Compensation and Benefitsunmatched
- Conflict Resolutionunmatched
- Contract Managementunmatched
- Contract Negotiationunmatched
- Cross-Functionalunmatched
- Data Collectionunmatched
- Employee Benefitsunmatched
- Financeunmatched
- Financial Managementunmatched
- Financial Modelingunmatched
- Forecastingunmatched
- Health Insuranceunmatched
- Health Planunmatched
- Healthcareunmatched
- Healthcare Administrationunmatched
- Healthcare Reimbursementunmatched
- Identify Issuesunmatched
- Leadershipunmatched
- Legalunmatched
- Medicaidunmatched
- Medicareunmatched
- Network Administration/Managementunmatched
- Operations Managementunmatched
- People Managementunmatched
- Preferred Provider Organization (PPO)unmatched
- Presentation/Verbal Skillsunmatched
- Product Planningunmatched
- Provider Contractingunmatched
- Regulatory Requirementsunmatched
- Reimbursementunmatched
- Strategic Planningunmatched
- Team Buildingunmatched
- Team Lead/Managerunmatched
- Writing Skillsunmatched
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