Organization: Sanford Health
Location: Sioux Falls, SD
Date Job Posted: September 13, 2022
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Lead, implement new, and expand Sanford Health Plan’s (SHP) government programs or portions of large scale initiatives. Project impact costs, quality, efficiencies and achievement of objectives across departments, often with enterprise-wide impacts. Lead operations of SHP's government programs including Medicare Advantage and Part D, ACA, future Medicaid expansion, and Medicare Supplement products. Profit and loss responsibility for government program lines of business.
Responsible for developing the operating model to successfully administer government programs. This includes insourcing/outsourcing strategy, vendor management and oversight, matrix reporting of SHP functions, and overseeing dedicated government programs team.
Partner with sales on the go-to-market strategy that includes marketing, sales and distribution strategies to achieve membership growth goals and the determination of service area expansion to grow market share.
Ensure plan operations meet the regulatory and/or contractual requirements of the respective government program.
Analyze competitors and product types to determine attractive benefits to differentiate SHP products through the annual bid process.
Provide strategic leadership, guidance and manage the STARs and risk adjustment program across SHP government programs.
Apply advanced technical, operational, contracting and insurance industry knowledge to solve complex problems which may impact service lines or corporate service or regional entity.
Partner in the development, negotiation and management of financially sound contracts with providers. Maintain a comprehensive and compliant network of health care providers, ensuring the provision of covered services to health plan members.
Manage the use of analytical resources and financial data to conduct and manage complex analyses, prepare and interpret impact reports, and recommend implement operational and contracting strategies and alternatives.
Ensure the alignment of contracting strategies, provider development and outcome management in a way that results in better quality and value.
A Master’s degree in health care, finance or a related field preferred
Minimum seven years of relevant experience required. A background or experience in health care reimbursement or contract negotiations preferred.