Job Description
- 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, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
- JOB SUMMARY/PURPOSE
- Provides advanced leadership in provider performance management and network optimization. Manages strategic provider relationships, leads complex performance initiatives, and serves as a senior escalation resource supporting the Plan Performance provider operating model.
- DEPARTMENT DESCRIPTION
- Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity
Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan
Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. 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.
- EXPERIENCE/EDUCATION/QUALIFICATIONS
- Bachelor’s degree in Healthcare Administration, Public Health, Health Informatics, or a related field, or equivalent related experience required.
- Four (4) years of experience in a healthcare payer, integrated delivery system, ACO, or value-based care environment required.
- Experience with the following tools required:
- Excel (advanced).
- Power BI/Tableau or similar visualization platforms.
- Experience in the following preferred:
- Population health or analytics platforms.
- Designing or improving provider workflows, performance improvement initiatives, or cross functional operational processes.
- Managed care leadership, with experience supporting D-SNP or dual-eligible populations.
- Delegated UM, delegated credentialing, or managing leased network environments.
- Lean Six Sigma or process improvement certification preferred.
- KNOWLEDGE/SKILLS/ABILITIES
- Healthplan and regulatory expertise, including working knowledge of Medicare Advantage program operations, Medicaid/CCO performance programs, CMS regulatory frameworks, NCQA accreditation and quality program expectations, delegated oversight model concepts, and provider network performance management
- Strong analytical and executive communication skills. Ability to use data storytelling to influence physician behavior.
- Ability to interpret healthcare performance data and translate into provider action.
- Ability to analyze dashboards including HEDIS / STARs measures, Risk Adjustment (RAF/HCC) Performance, Access and Utilization Metrics, and Provider Experience Indicators.
- Ability to identify performance drivers and root causes across clinical and operational workflows.
- Working knowledge of Risk Adjustment methodology (HCC/RAF concepts), documentation and recapture workflows, annual visit/wellness visit operational models, and preventative chronic care quality improvement strategies.
- 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)CLIMB - STAIRS
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 pounds
BEND FORWARD at waist
KNEEL (on knees)
STAND
WALK – LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0 - 20 pounds force)
PULL (0 - 20 pounds force)
SIT
CARRY 2-handed, 0 - 20 pounds
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
Numbers & Facts
| Location | Corvallis, OR (Remote) |
Skills
- Analysis Skillsunmatched
- Capacity and Performance Managementunmatched
- Centers for Medicare and Medicaid Services (CMS)unmatched
- Communication Skillsunmatched
- Cross-Functionalunmatched
- Documentationunmatched
- Health Informaticsunmatched
- Health Planunmatched
- Healthcareunmatched
- Healthcare Administrationunmatched
- Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
- Healthcare Providersunmatched
- Leadershipunmatched
- Lean Six Sigmaunmatched
- Legalunmatched
- Managed Careunmatched
- Medicaidunmatched
- Medicareunmatched
- Metricsunmatched
- National Committee for Quality Assurance (NCQA)unmatched
- Network Administration/Managementunmatched
- Operations Processesunmatched
- Performance Managementunmatched
- Performance Modelingunmatched
- Power BIunmatched
- Preventive Medicineunmatched
- Process Improvementunmatched
- Product Planningunmatched
- Public Healthunmatched
- Quality Managementunmatched
- Regulationsunmatched
- Reporting Dashboardsunmatched
- Riskunmatched
- Risk Analysisunmatched
- Royal Air Forceunmatched
- Storytellingunmatched
- Strategic Planningunmatched
- System Integration (SI)unmatched
- Tableauunmatched
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