Director of Network Performance

Job Number: 2134

Workplace Type:

Position Title: Director, Network Management

External Description:

Position Summary: Reporting to VP of Network, 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.
Minimum Requirements:
1. Minimum Experience:
a. 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.
2. Education/Licensure:
a. Requires a BA/BS; MBA strongly preferred.
3. Other:
a. Must have strong analytical skills
b. Excellent knowledge of hospitals and managed care finance and contracts
c. Strong knowledge of Medicare managed care and associated contract language
d. Excellent interpersonal and relationship management skills
e. Excellent oral, written and presentation skills
f. Proven ability to foster collaboration, value others perspective and gain support and
buy-in for organization proposal.
g. Excellent Microsoft Office skills, including Word and Excel
h. Experience with delegated and non-delegated providers
i. Ability to travel by car or air
j. Available for evenings/weekends and extended work hours as needed
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.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Director of Network Performance

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply 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 over 1,300 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. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

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 [email protected].