SHP Provider Contracting Consult-Senior
Corvallis, OR
SHP Provider Contracting Consult-Senior
Remote provider contracting work leading complex initiatives across Medicaid, Medicare Advantage, and Commercial lines, including negotiations, financial modeling, and value-based payment design. Requires a bachelor’s degree or equivalent experience, 4 years’ managed care contracting experience, and expert Excel skills.
- 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, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
- JOB SUMMARY/PURPOSE
- Responsible for leading complex, high-value provider contracting initiatives across Medicaid, Medicare Advantage, and Commercial lines of business. Participates in the development of and executes multi-year contracting strategies for hospitals, health systems, large physician organizations, and other strategic providers. Serves as a subject matter expert in reimbursement methodologies, value-based payment design, and regulatory compliance. Leads high-stakes negotiations, performs advanced financial modeling, advises executive leadership on network strategy, and mentors contracting staff. Exercises broad discretion within delegated authority and significantly influences organizational cost-of-care, network adequacy, and quality performance outcomes.
- 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 and Commercial Large Group plans. 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 Business Administration, Healthcare Administration, Finance, or a related field, or equivalent related experience required.
- Four (4) years of progressive provider contracting experience in a managed care environment required.
- Experience negotiating complex hospital, health system, and risk-based agreements required.
- Experience across Medicaid, Medicare Advantage, and Commercial product lines required.
- Extensive experience designing and managing value-based payment and alternative payment models required.
- KNOWLEDGE/SKILLS/ABILITIES
- Deep understanding of federal and state regulatory requirements. Expert-level knowledge of healthcare reimbursement methodologies (DRG/IPPS, OPPS, capitation, percent-of-Medicare, bundled payments, risk arrangements).
- Advanced financial modeling and analytical skills (expert-level Excel proficiency required).
- Ability to manage multiple high-priority initiatives simultaneously. Exceptional negotiation, influence, and conflict resolution skills.
- Strong executive presence and ability to communicate complex financial concepts to senior leadership.
- Strategic thinker with strong business and market acumen.
- Proven leadership and mentoring capability.
- 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)
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