Senior Manager, 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 Sr. Manager, Network Management is responsible for contracting with all provider types and successful provider network performance related to key financial, operational, and member satisfaction performance indicators in a multi-market territory. Works closely with Network Management and other departments to enhance the contracted provider experience consistent with company’s mission statement and values.

General Duties/Responsibilities (May include but are not limited to):

• Collaborate with Network Management leadership in the development and execution of the contracting strategy.
• Recruit providers to eliminate network deficiencies within a specific region.
• Negotiate / re-negotiate and finalize all contracts which may be primary care, specialist, ancillary, hospital, group/IPA as well as ensure the accuracy of administration of these agreements.
• Manage staff; lead, mentor and coach staff effectively
• Assure the day-to-day operations of the provider network are consistent with standards/ expectations and develops provider education materials as needed to support adherence with company requirements.
• Develop agendas and lead Joint Operations Meetings to drive results, including oversight of New Provider Orientations and new Contract Orientations.  Meetings will focus on addressing performance improvement metrics, resolving operational issues, including but not limited to utilization management, financial, enrollment, member appeals and grievances, provider termination/panel closures, continuity of care, and marketing activities.
• Responsible for the execution of regional work-plans, monitoring performance metrics, updating status, and communicating progress both internally and externally to ensure results.
• Responsible for timely and professional interaction with internal and external customers.
• Ensure accurate and timely data reporting requirements are being met for designated regions, including but not limited to provider network contacts, eligibility and capitation reports, risk sharing, claims timeliness, pharmacy utilization, bed day utilization, encounter data and audit compliance.
• Develop goals and objectives that align with Network Management leadership’s  performance metrics to ensure department KPIs are met, as well as the organization’s vision for future growth and network development.
• Utilize contracting knowledge for effective problem resolution and compliance.  Responsible for timely and professional interaction in response to grievances.  Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.
• Create and implement policies and procedures for the department. Interpret company policies and procedures. 
• Represents the department in interdepartmental meetings and selected committees.
• Other projects and responsibilities as assigned

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.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

Minimum 5-7 years’ experience with an HMO, managed care provider organization (IPA, Medical Group or institutional provider) or insurance company with at least 5 years’ specific experience in managed care contracting and knowledge or Medicare Advantage regulatory guidelines.

Previous supervisory experience; demonstrated abilities to manage staff

Education/Licensure:

Bachelor’s Degree or equivalent experience required

Other:

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