Director of Customer Care and Appeals/Grievances

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. We are open to remote out of state work in any of our approved 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, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin. # JOB SUMMARY/PURPOSE Accountable for leading various Samaritan Health Plan Operations departments that provide services to both member and providers (Member and Provider Customer Service, Appeals and Grievances, Member Outreach and Member Concierge). Employs customer experience guiding principles and customer commitments to support and improve the customer experience. Directs the customer service call center activities, ensuring that the highest level of customer service and support are achieved. Directs the appeals and grievances activities across all lines of business to achieve all regulatory and company goals. Responsible for member outreach activities to collect insight on member health which is used to prepare effective care plans. Advocates for members to improve access to care. Serves as a strategic thought leader who designs, develops, and leverages technology and human capital to deliver best in class performance and member experience. # EXPERIENCE/EDUCATION/QUALIFICATIONS Bachelor#s degree or equivalent experience required. Master#s degree preferred. Five (5) years progressive leadership experience required. Significant site management experience including leading large teams and managing cross functional teams preferred. Three (3) years experience with managed care required. Experience with Medicaid and Medicare strongly preferred. Experience or training in computer applications including electronic documentation 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

* 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.


* We are open to remote out of state work in any of our approved 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, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin.
*
* JOB SUMMARY/PURPOSE
* Accountable for leading various Samaritan Health Plan Operations departments that provide services to both member and providers (Member and Provider Customer Service, Appeals and Grievances, Member Outreach and Member Concierge). Employs customer experience guiding principles and customer commitments to support and improve the customer experience. Directs the customer service call center activities, ensuring that the highest level of customer service and support are achieved. Directs the appeals and grievances activities across all lines of business to achieve all regulatory and company goals. Responsible for member outreach activities to collect insight on member health which is used to prepare effective care plans. Advocates for members to improve access to care. Serves as a strategic thought leader who designs, develops, and leverages technology and human capital to deliver best in class performance and member experience.




* EXPERIENCE/EDUCATION/QUALIFICATIONS
* Bachelor's degree or equivalent experience required. Master's degree preferred.


* Five (5) years progressive leadership experience required. Significant site management experience including leading large teams and managing cross functional teams preferred.


* Three (3) years experience with managed care required. Experience with Medicaid and Medicare strongly preferred.


* Experience or training in computer applications including electronic documentation 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