Director, Contracting & Network Management

Location: Remote-Henderson, Nevada US

Notice

This position is no longer open.

Job Number: 2879

Workplace Type:

Position Title: Director, Contract Network Management

External Description:

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. 

Position Summary: 

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. 

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: 

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. 

 

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

  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. 
  1. 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 [email protected].

City: Remote-Henderson

State: Nevada

Location City: Remote-Henderson

Location State: Nevada

Community / Marketing Title: Director, Contracting & Network Management

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].