Delegate Operations Program Manager II

Delegate Operations Program Manager II

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures : InterCommunityHealth 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.

Candidates residing out of state will need to be able to work Pacific Time Zone hours.

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, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

Primary Responsibilities :

• Lead the annual subcontractor performance review process for all assigned delegated entities.
• Develop and update all audit tools.
• Conduct and document audits of delegated entity operations, ensuring alignment with OHA requirements.
• Collaborate directly with delegates to gather data, resolve issues, and support performance improvement.
• Prepare and submit comprehensive performance and audit reports to the internal compliance team and government programs.
• Maintain tracking systems and dashboards for delegated entity oversight.
• Serve as a liaison between delegates and internal departments, including participation in any necessary oversight committee’s
• Develop, maintain, and regularly update all program-owned policies and procedures to ensure alignment with organizational standards and regulatory requirements.

Preferred candidates will have the following :

EXPERIENCE / EDUCATION / QUALIFICATIONS

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.

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

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