Director, Network Management

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most : the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Director, Network Management, is responsible for meeting the network management needs for assigned geography and / or health delivery networks. Working closely with the regional executive teams, and leads the market's clinical performance activity related to growth, CAHPS, RAF and STARS measures and produce outcomes consistent with corporate guidelines and requirements. Offers technical leadership and expertise to both regional and corporate initiatives for physician, hospital, and ancillary contracted networks. Which shall include direct communication to improve quality performance goals with IPA and Hospitals. Oversee, as assigned Regional Performance of Network.

GENERAL DUTIES / RESPONSIBILITIES

1. Leads and facilitates join operations committee meetings (JOC) with MSO, IPA and Direct Ancillary contracted providers.

2. Leads and manages provider service representatives to maximize engagement through consistent face-to-face interactions, in-service visits, training sessions and JOC participation to improve performance and growth initiatives.

3. Reviews, analyzes and develops strategies based on historical performance data and trend performance metrics promoting growth, CAHPS, RAF, STARS, Benefit Orientation, AVA (Alignment Virtual Application). Types of providers : PCP, Specialist, SNFs, ASCs, Home-Health, DMEs (all ancillary providers).

4. Trains and manages direct reports to capture and document provider interactions in the designated database to ensure proper tracking of action items and performance metrics are being followed.

5. Oversight of provider service representative's strategy and schedules to ensure department goals and requirements are being met.

6. Weekly status update to VP - Track and report network performance and opportunities for assigned regions

7. Analyzes current and projected network needs from cost / utilization and competitor standpoints.

8. Collaborates with regional executive team and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, RAF, and other initiatives.

9. Contributes expertise to development of organizational best practices.

Job Requirements : Experience :

• Required : Minimum 10 years of experience in managed care or health care field, with a solid understanding of reimbursement methodologies, contract language, negotiation strategies, financial modeling and analysis, managed care and Medicare Advantage plans; or any combination of education and experience, which would provide an equivalent background. Minimum 5 years of experience with delegated and non-delegated providers. Minimum 2 years of supervisory experience.
• Preferred : 5 years of supervisory experience

Education :

Required : High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.

Preferred : MBA

Specialized Skills :

Required :

Excellent knowledge of hospitals and managed care finance and contracts

Solid knowledge of Medicare managed care and associated contract language

Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal.

Excellent Microsoft Office skills, including Word and Excel

Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.

Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

Mathematical Skills : Ability to perform mathematical calculations and calculate simple statistics correctly

Reasoning Skills : Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.

Problem-Solving Skills : Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Report Analysis Skills : Comprehend and analyze statistical reports.

Licensure :

Required : None

Other :

Ability to travel by car or air

Available for evenings / weekends and extended work hours as needed

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and / or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range : $109,932.00 - $164,899.00

Alignment Health is an Equal Opportunity / Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

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