Sr. 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 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

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 v