Samaritan Health Services ยท 1 month ago
Health Plans Program Manager - Contract Performance Oversight
United States
Contract
Remote
Mid, Senior Level
3+ years expSamaritan Health Services is a provider of health insurance options, operating under various legal structures for Medicaid beneficiaries and Medicare members. The Health Plans Program Manager is responsible for overseeing the IHN/CMS Program, ensuring compliance with regulations, and driving program improvements while collaborating with various stakeholders.
Health CareHospital
Responsibilities
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
Qualification
Required
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
Preferred
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
Company
Samaritan Health Services
Samaritan Health Services provides compassionate, innovative and quality health care serving communities.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Marty Cahill MBA, FACHE
Chief Executive Officer
Brandon Schmidgall
Chief Operating Officer
Recent News
Fierce Healthcare
2025-10-27
2025-05-25
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