Sr. Director, Network Management (must reside in Santa Clara County)

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is championing a new path in senior care! From member experience professionals and clinicians to data scientists and operations leaders, we have built a talented and passionate team that is committed to our mission of transforming health care for the seniors we serve. Ready to join us? 

 

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. Whether you’re in a clinical setting, corporate office, or home office, we believe in supporting continuous learning and growth for your career. 

The Senior Director, Network Management, is accountable for the development, growth, and performance of their assigned geography and/or health delivery networks. Works closely with the regional executive teams, the Sr. Director will lead the market’s clinical performance activity related to growth, CAHPS, MRA 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. Includes direct communication to improve quality performance goals with IPA and Hospitals. Oversees, as assigned Regional Performance of Network.

GENERAL DUTIES/RESPONSIBILITIES:
1.    Develops and executes strategies for optimal network and network development in established and new markets.
2.    Leverages the competitive landscape to assess and design network and contracting strategies.
3.    Works with multidisciplinary team to produce desired growth, financial, and operational outcomes.
4.    Collaborates with the regional executive team and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, MRA, and other initiatives.
5.    Works closely with Regional Medical Officer and collaborates with other departments to ensure overall success of the market.  Meets and exceeds budget and operating goals.
6.    Identifies and contracts with new PCPs and specialists to develop the network.
7.    Analyzes current and projected network needs from cost/utilization and competitor standpoints. 
8.    Partners with Contracting to analyze and negotiate contract rate and language proposals.
9.    Develops solid relationships with key external stakeholders, physician leaders, network physicians, hospitals, and ancillary providers.
10.    Partners with Sales and Member Experience teams to develop and execute growth and retention plans.
11.    Leads and manages IPA market management resources to ensure execution of operating, performance, and growth initiatives. 
12.    Leads and manages Provider Service Representatives to maximize engagement through consistent face-to-face interactions, in-service visits, training sessions, and outcome reviews.
13.    Weekly status update to Regional VP - Tracks and reports network performance and opportunities for assigned regions.
14.    Contributes expertise to development of organizational best practices.

Supervisory Responsibilities:

Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees. Will also oversee third-party vendors and/or student workers as appropriate.

Job Requirements:

Experience:

• Required: Minimum 10+ years of experience in managed care or health care field, including 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

• Preferred:

Education:

• Required: Bachelor's degree.

• Preferred: MBA

Training:

• Required:

• Preferred:

Specialized Skills:

• Required:

• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Excellent knowledge of hospitals and managed care finance and contracts
• Solid knowledge of Medicare managed care and associated contract language
• ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal.
• Excellent Microsoft Office skills, including Word and Excel
• 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
• May be requested to work 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: $172,364.00 - $258,547.00

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.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.