Manager of Enrollment and Provider 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.