Manager - Enrollment and Health Plan Data

JOB SUMMARY/PURPOSE Oversees and manages the member enrollment and PDM operations to ensure accuracy, efficiency, and compliance with regulatory requirements and internal policies. Supports the overall integrity of provider data to facilitate efficient operations and exceptional service delivery. Leads a team of professionals and works collaboratively with other departments to optimize processes, enhance service delivery, and achieve organizational goals.# DEPARTMENT DESCRIPTION Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures:
InterCommunity 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/EDUCATION/QUALIFICATIONS Bachelor#s degree in Healthcare Administration, Business Administration, Information Management, or a related field; or equivalent experience required. Master#s degree preferred. Three (3) years experience in enrollment and/or provider data management within a managed care organization or a similar healthcare setting required. Two (2) years progressive leadership experience required. Experience in healthcare regulations, including Medicare and Medicaid, required. Experience in healthcare management systems and data analytics tools 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 Lbs CARRY 1-handed, 0 - 20 pounds CARRY 2-handed, 0 - 20 pounds KNEEL (on knees) BEND FORWARD at waist CLIMB - STAIRS STAND WALK - LEVEL SURFACE ROTATE TRUNK Standing REACH - Upward PUSH (0-20 pounds force) PULL (0-20 pounds force) SIT ROTATE TRUNK Sitting REACH - Forward MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist None specified

• JOB SUMMARY/PURPOSE

• Oversees and manages the member enrollment and PDM operations to ensure accuracy, efficiency, and compliance with regulatory requirements and internal policies. Supports the overall integrity of provider data to facilitate efficient operations and exceptional service delivery. Leads a team of professionals and works collaboratively with other departments to optimize processes, enhance service delivery, and achieve organizational goals.

• DEPARTMENT DESCRIPTION

• Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures:
InterCommunity 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/EDUCATION/QUALIFICATIONS

• Bachelor's degree in Healthcare Administration, Business Administration, Information Management, or a related field; or equivalent experience required. Master's degree preferred.

• Three (3) years experience in enrollment and/or provider data management within a managed care organization or a similar healthcare setting required.

• Two (2) years progressive leadership experience required.

• Experience in healthcare regulations, including Medicare and Medicaid, required.

• Experience in healthcare management systems and data analytics tools 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 Lbs

CARRY 1-handed, 0 - 20 pounds

CARRY 2-handed, 0 - 20 pounds

KNEEL (on knees)

BEND FORWARD at waist

CLIMB - STAIRS

STAND

WALK - LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0-20 pounds force)

PULL (0-20 pounds force)

SIT

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands/wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand/Fist

None specified