Samaritan Health Services-posted 13 days ago
Mid Level
Remote • Corvallis, OR
5,001-10,000 employees
Administrative and Support Services

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: InterCommunityHealthPlans, 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. JOB SUMMARY/PURPOSE This role is accountable for the oversight, implementation, and ongoing improvement of the IHN / CMS Program across our Coordinated Care Organization, ensuring compliance with regulatory requirements, alignment with organizational goals, and responsiveness to the needs of members and provider partners. 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, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

  • Develop and manage the IHN / CMS program to align with OHA / CMS regulations, organizational strategy, and evolving healthcare policies.
  • Leading the development, implementation, and execution of program strategies and related projects.
  • Collaborate with internal and external stakeholders to ensure program goals are met and aligned with broader agency objectives.
  • Providing organization-wide training, guidance, and mentorship on program objectives and processes.
  • Drive innovation and continuous improvement initiatives to enhance program outcomes and member experience.
  • Facilitate collaboration across departments including Operations, Clinical, HPIS, Compliance, and Finance.
  • Build strong relationships with state agencies, vendors, and other external partners.
  • Ensure the voice of the customer (e.g., members, providers, case managers) is reflected in program decisions.
  • Monitor progress, manage risks, and resolve issues to maintain program momentum.
  • Develop and implement internal performance improvement plans when necessary to ensure compliance and performance standards.
  • Communicate program status, milestones, and outcomes to stakeholders at all levels.
  • Stay current on policy changes and assess their impact on program operations.
  • Ensure all program activities comply with CMS and OHA regulations.
  • Support audit readiness and documentation for regulatory reviews.
  • Partnering with SHP experts to maintain focus, alignment, and best practices.
  • Bachelor#s Degree in a related field or equivalent experience required.
  • Three (3) years directly related experience in a managed care/health plan/health insurance setting required.
  • Leadership experience required.
  • Experience in management principles, practices, policies, procedures and regulations as they relate to assigned program(s) required.
  • Experience and/or training in computer applications, including word processing and spreadsheet software, required.
  • Experience working with state Medicaid agencies or managed care organizations.
  • Experience with Medicaid contract compliance reporting
  • Familiarity with Oregon Health Authority (OHA) policies and the Coordinated Care Model.
  • PMP or similar project management certification.
  • Lean Six Sigma certification.
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