Job description

Create Your Career With Us!

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Cherapa Place Building

Location: Sioux Falls, SD

Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA

Shift: Day

Job Schedule: Full time

Weekly Hours: 40. 00

Job Summary

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.

Qualifications

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.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0117739

Job Function: Health Plan

Featured: No

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