Director, Network Management (San Diego County)

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, s/he will lead the market’s clinical performance activity related to growth, CAHPS, RAF and STARS measures and produce outcomes consistent with corporate guidelines and requirements. The Director, of Network Management will offer 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 (May include but are not limited to):

• Lead and facilitate join operations committee meetings (JOC) with MSO, IPA and Direct Ancillary contracted providers.
• Lead and manage 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.
• Review, analyze and develop 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).
• Train and manage 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.
• Collaborate 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.

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:

10 years of experience in managed care or health care field, including a strong 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.

Experience with delegated and non-delegated providers

Education/Licensure:

Requires a BA/BS; MBA preferred.

Other:

Must have strong analytical skills and customer service skills.

Excellent knowledge of hospitals and managed care finance and contracts

Strong knowledge of Medicare managed care and associated contract language

Excellent interpersonal and relationship management skills

Excellent oral, written and presentation skills

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 travel by car or air

Available for evenings/weekends and extended work hours as needed

Work Environment

The work environment characteristics de