Director, Network Management (San Diego County)

San Diego, CA - USA

Monthly Salary: $ 113332 - 169999

Posted on: 10 hours ago

Vacancies: 1 Vacancy

Job Summary

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 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 markets 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 representatives 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 requirements listed below are representative of the knowledge skill and/or ability 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 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.

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. 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: $113332.00 - $169999.00

Pay range may be based on a number of factors including market location education responsibilities experience etc.

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 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 you feel that you have been the victim of a scam such as this please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team please email .

Required Experience:

Director