Provides leadership and direction to the Provider Contracting and Provider Network Management functions for Samaritan Health Plans. Leads and drives the development and execution of comprehensive provider strategies that support both health plan and integrated system objectives. Develops and maintains key strategic relationships and partnerships with regional providers to advance key business objectives. Ensures there is appropriate provider network breadth and stability to support product and enrollment objectives.
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, 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.
Bachelor's degree or equivalent experience in a related field required.
Six (6) years experience in the health care industry required.
Four (4) years experience in provider contracting for a health plan or payor contracting for a delivery system required.
Three (3) years management experience required.
Experience in a wide variety of provider reimbursement methodologies such as RBRVS fee schedules, per diems, DRGs, budgeted care models such as capitation, and other forms of value-based reimbursement strongly preferred.