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. See yourself at Sanford! **Facility:** Cherapa Place Building **Location:** Sioux Falls, SD **Shift:** 8 Hours - Day Shifts **Job Schedule:** Full time **Weekly Hours:** 40.00 **Job Summary** Leads Sanford Health Plan operations of Medicare Advantage and Part D products within the framework of Chapter 21, Compliance Program Guidelines, of the Medicare Managed Care Manual. This includes, but is not limited to provider contracting, provider relations, customer service, marketing, sales, enrollment and other day-to-day operations. Manages participating provider preferred relationships in designated region(s) and coordinates training to all ISNP facilities to ensure they are prepared to offer ISNP services including having fully developed accessible networks, which are trained and versed in the model of care requirement and prepared to achieve or exceed goals. Accountable for complying with all related laws, regulations, company policies and procedures pertaining to position. Manages marketing and sales activity to support achievement of enrollment goals. Carries out operations and tactics to achieve budget and financial performance for ISNP. Executes management and outreach to all key providers currently delivering services to facility residents. Engages key providers to participate in ISNP program(s) at the facility. Supports provider relations and contracting staff as appropriate to determine and achieve contracting goals. Responsible for coordinating operational functions related to the respective assigned facilities and participates in a joint team effort of delivering high quality and cost-effective care in conjunction with facility, plan, and corporate staff and management. Collaborates with finance and performance analysis teams to identify cost savings initiatives and monitor contract performance. Carries out operational policies and procedures that support organizational improvements and comply with federal and state requirements. Supports policies and programs that encourage employees and related entities to report suspected fraud and other improprieties without fear of retaliation. Assists in the annual actuarial bid process aids in validating accuracy of the ISNP's bid. **Qualifications** Bachelor's degree in health care, finance or a related field. Minimum five years of relevant experience required. A background or experience in health care reimbursement or contract negotiations preferred. 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 firstname.lastname@example.org . **Job Function:** Health Plan **Req Number:** R-20232 **Featured:** No
About Sanford Health
Sanford Health is an integrated health system headquartered in the Dakotas. It is the largest, rural, not-for-profit health care system in the nation with 45 hospitals and 289 clinics in nine states and three countries. With 28,000+ employees, including 1,300+ physicians in more than 80 specialty areas of medicine, Sanford Health is the largest employer in the Dakotas.
Nearly $1 billion in gifts from philanthropist Denny Sanford have allowed for several initiatives, including global children’s clinics, genomic medicine and specialized centers researching cures for type 1 diabetes, breast cancer and other diseases.