Health Plans Program Manager - Oversight

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:
Inter Community 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.

• 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.

• 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

• 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.

• 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.

• 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