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.

• Leads and facilitates join operations committee meetings (JOC) with MSO, IPA and Direct Ancillary contracted providers.
• 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.
• 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).
• 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.
• Oversight of provider service representative’s strategy and schedules to ensure department goals and requirements are being met.
• Weekly status update to VP - Track and report network performance and opportunities for assigned regions
• Analyzes current and projected network needs from cost/utilization and competitor standpoints.
• Collaborates with regional executive team and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, RAF, and other initiatives.
• Contributes expertise to development of organizational best practices.

• 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

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

• 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.

• Required:
  
  None

• Ability to travel by car or air
• Available for evenings/weekends and extended work hours as needed

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…