Director of Network Development & Contracting

Director of Network Development & Contracting

Schedule - Shift 1.0 (80 hrs/pp) - Day

Department SHS Health Plan Operations - Finance

*Starting bonus and/or relocation available to new employees. Previous experience may be required. Employment commitment to Samaritan is required.

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 LbsCARRY 1-handed, 0 - 20 pounds