Job Information
Sanford Health Director, Medicare Programs in Sioux Falls, South Dakota
Careers With Purpose
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.
Facility: GSS National Campus
Location: Sioux Falls, SD
Address: 4800 W 57th St, Sioux Falls, SD 57108, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Department Details
This leadership role is focused on the Institutional Special Needs Plans (I-SNP) program, delivering high-quality, coordinated care for institutionalized and often underserved populations. The role leads strategic sales efforts to drive program growth while maintaining a strong commitment to member-centered outcomes, provider relations, and facility partnerships. The position partners closely with providers and interdisciplinary teams to enhance member experience and improve health outcomes. This is an ideal opportunity for a mission-driven leader who is passionate about expanding access to thoughtful, high-quality care.
Job Summary
Responsible for the performance, strategic leadership, product development and management, program direction and oversight of all functions and processes related to Sanford Health Plan (SHP) Medicare Programs. Ensures Medicare programs are leveraged as a strategic asset across the Sanford Health Enterprise. Directs the day-to-day operations of the government programs department. Develops and implements business plans, bids, and operational budgets that lead to achieving business goals and strategies. Leads efforts to launch and operationalize Sanford's Medicare Advantage insurance products. Manages and develops Medicare product portfolio to create an assortment of product offerings to optimize membership. Works on complex compliance matters where analysis of issues, data and process require advanced specialist knowledge and in-depth industry and technical knowledge.
Develops and integrates improvements in health provider engagement, member engagement, health improvement programs, administrative excellence and data analytics. Reviews department goals and objectives accordingly. Drives quality performance through external data sources such as Centers for Medicare and Medicaid Services (CMS) star ratings and Healthcare Effectiveness Data and Information Set (HEDIS) to achieve goals and targets.
Provides guidance regarding emerging market opportunities to identify business threats, look for strategic solutions and develop strategies to address business issues and industry trends. Investigates and leads government program product development with growth targets, strategic initiatives and service area expansions and execute new products and programs.
Drives the launch of new Medicare products, from inception through implementation, working with internal teams and external partners to ensure a successful implementation and go-to-market delivery.
Acquires and maintains professional expertise in, and promote effective understanding of government programs organizational requirements and government regulations. Sets the vendor strategy to balance administrative costs with predicted medical cost. Develops and maintains superior professional relationships with key stakeholders and internal functional areas designed to ensure program consistency and alignment of care management, network contracting and claims operations programs. Maintains strong integration with health services division.
Possesses strong leadership capabilities and delegates responsibility accordingly. Holds team accountable for meeting and exceeding established metrics and goals. Maintains expert knowledge in different Medicare programs, such as Medicare Advantage Plans, Individual Special Needs Plans and Medicare supplemental plans.
Qualifications
Bachelor's degree in health care, finance or a related field required.
Minimum of seven years' required experience working in health insurance operations with expertise or experience in: provider relations, provider back office operations, product, accounting/finance, compliance, or related fields.
Minimum of five years of government programs management experience preferred.
Minimum of five years related work experience or combination of seven years of transferrable experience and education in the areas of consulting, health plan operations, provider relations, or government programs preferred.
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .
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 talent@sanfordhealth.org .
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0257244
Job Function: External Affairs
Featured: No