Director, Contracting & Network Management
Location: Remote-Henderson, Nevada US
Job Number: 2879
Position Title: Director, Contract Network Management
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. 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 community.
The Director, Contracting and Network Management is responsible for meeting the contracting and 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 contracting activity and produce outcomes consistent with corporate guidelines and requirements. The Director, Contracting and Network Management will offer technical contracting leadership and expertise to both regional and corporate initiatives for physician, hospital and ancillary contracting. Which shall include direct contract negotiations with IPA and Hospitals. Oversee, as assigned Regional Performance of Network.
General Duties/Responsibilities (May include but are not limited to):
- In conformance with corporate standards, including network adequacy requirements and performance targets, negotiates, implements, and manages capitated and fee-for-service agreements with individually contracted Primary Care Physicians (PCP), medical groups, hospitals, ancillary providers and specialists.
- Analyzes current and projected network needs from cost/utilization and competitor standpoints.
- Analyzes, negotiates, and drafts contract rate and language proposals consistent with corporate guidelines for language, financial and operational performance.
- Oversees administration of the contracts to ensure anticipated results, identify negative performance trends, and implement cost containment and other improvement strategies.
- Collaborate with regional executive team and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, RAF, and other initiatives.
- Oversees any required contract amendments and resolves contract issues.
- Contributes expertise to development of organizational best practices.
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.
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.
- Requires a BA/BS; MBA strongly preferred.
- Must have strong analytical 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
- Experience with delegated and non-delegated providers
- 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.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact firstname.lastname@example.org.
Location City: Remote-Henderson
Location State: Nevada
Community / Marketing Title: Director, Contracting & Network Management
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.