Network Management Specialist

Location: Raleigh, North Carolina US

Notice

This position is no longer open.

Job Number: 2765

Workplace Type:

Position Title: Network Management Specialist

External Description:

Position Summary: 
The Network Management Specialist will assist in building and maintaining high-performance provider networks by identifying opportunities to grow membership, contract with providers, and improve the contractual performance. Works closely with 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) 

  • Supports efforts to improve Group/IPA financial performance by tracking and evaluating performance measures such as risk pool performance and bed day utilization and cost trends, identification, analysis and resolution of problem areas, communicating improvement requirements to providers/management team, and influencing provider to make systemic and operational improvements. 
  • Prepares supporting documentation, negotiates and implements contracts for physicians and ancillary providers for both existing and developing markets. 
  • Acts as technical resource on provider relations issues. Responsible for timely and professional interaction with internal and external customers. 
  • Enhances the relationship with provider organizations by organizing timely, effective Joint Operations Meetings and provider orientations, with appropriate data sharing, by efficiently and effectively responding to requests for information, by monitoring and influencing physician growth opportunities and trends, and by successfully resolving issues related to capitation, claims, and other operational functions. 
  • Assists other departments by sending out communication notices to external providers as well as distributing any documentation and performance measures to drive engagement. 
  • Utilizes understanding of the business risk relationships to interact and influence Physician Group Administrators and key physician leaders. 
  • Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures. 
  • Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and time frames. 
  • Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of PCP terminations with member reassignment, as well as group terminations in accordance with the Block Member Transfer P & P. Maintains understanding of physician affiliation patterns and trends, and the political/financial forces driving network movement. 
  • Promotes enrollment growth by supporting Marketing & Sales Department event planning and execution. 
  • Supports department efforts and Network Management Directors by participating in interdepartmental meetings and selected committees. 
  • Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. 
  • Contributes to team effort by accomplishing related results as needed. 

Minimum Requirements: 

  1. Minimum Experience:
    1. Minimum 5+ years’ experience in provider relations/contracting with an HMO or IPA, medical group or institutional provider required, or a combination of education and experience may considered.
  2. Education/Licensure:
    1. Bachelor’s Degree preferred.
  3. Other:
    1. Strong analytic, quantitative, and problem-solving skills required.
    2. Strong verbal and written communication skills required.
    3. Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
    4. Proficiency in MS Word and Excel required; Access database proficiency preferred.

Conditions of Work

  • Office Hours: Monday-Friday, 8am to 5pm.  Extended work hours, as needed.
  • 20-60% or more travel by car routinely required for Specialists.
  • Travel by plan required as needed to support provider services needs in other geographies.
  • Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.

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: Raleigh

State: North Carolina

Location City: Raleigh

Location State: North Carolina

Community / Marketing Title: Network Management Specialist

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].