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 Responsible for leading complex, high-value provider contracting initiatives across Medicaid, Medicare Advantage, and Commercial lines of business.
Participates in the development of and executes multi-year contracting strategies for hospitals, health systems, large physician organizations, and other strategic providers. Serves as a subject matter expert in reimbursement methodologies, value-based payment design, and regulatory compliance. Leads high-stakes negotiations, performs advanced financial modeling, advises executive leadership on network strategy, and mentors contracting staff.
Exercises broad discretion within delegated authority and significantly influences organizational cost-of-care, network adequacy, and quality performance outcomes. 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 Business Administration, Healthcare Administration, Finance, or a related field, or equivalent related experience required. Four (4) years of progressive provider contracting experience in a managed care environment required.
Experience negotiating complex hospital, health system, and risk-based agreements required. Experience across Medicaid, Medicare Advantage, and Commercial product lines required. Extensive experience designing and managing value-based payment and alternative payment models required.
KNOWLEDGE/SKILLS/ABILITIES Deep understanding of federal and state regulatory requirements. Expert-level knowledge of healthcare reimbursement methodologies (DRG/IPPS, OPPS, capitation, percent-of-Medicare, bundled payments, risk arrangements). Advanced financial modeling and analytical skills (expert-level Excel proficiency required).
Ability to manage multiple high-priority initiatives simultaneously. Exceptional negotiation, influence, and conflict resolution skills. Strong executive presence and ability to communicate complex financial concepts to senior leadership.
Strategic thinker with strong business and market acumen. Proven leadership and mentoring capability. 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