VP, Market President - AZ

Location: Remote, Arizona US

Notice

This position is no longer open.

Job Number: 2908

Workplace Type: Fully Remote

Position Title: VP, Market President

External Description:

Alignment Healthcare is a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options through Alignment Health Plan, and also partners with select health plans to help deliver better benefits at lower costs.

By becoming a part of the Alignment Healthcare team, you will provide Medicare enrolled consumers 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:

Reporting to the President of Markets, the President of Arizona shares responsibility for ensuring successful and efficient health plan operations, and for achieving profitability of the state.  Working closely with the Regional Medical Officer, Chief Medical Officer and the executive team, s/he will lead the state’s provider network relationships and performance.

General Duties/Responsibilities (May include but are not limited to):

·       Develops and executes the P&L strategy for the state and has shared P&L responsibility for the plan

·       Works closely with Medical Officers and collaborates with other departments to ensure overall success of the market.  Meets and exceeds budget and operating goals

·       Directly responsible for sales and the FMO to ensure optimal enrollment and retention of members

·       Assesses, follows up and engages network providers to maximize referrals of patients to Care Centers

·       Ensures that all new members are scheduled for and complete a Jump Start Assessment within the first 60 days of membership for proper coding

·       Assists in the top-line activities of the market and ensures all market goals are met

·       Develops strong relationships with key stakeholders including physician leaders, network physicians, hospitals and ancillary providers

·       Develops, coordinates and drives JOC agendas

·       Monitors market performance and implements standardized performance report cards and improvement plans for utilization and identified cost outliers; incorporates new, innovative, emerging and/or effective quality and cost control programs

·       Conducts monthly market review meetings with corporate leaders

·       Ensures PCP Rosters (demographics) and provider directories are current locally and at corporate

·       Executes Health Plan compliance requirements in accordance with CMS regulations

·       Develops and implements initiatives to increase patient satisfaction, coding accuracy, STARS, and other quality programs

·       Analyzes, negotiates, and drafts contract rate and language proposals in accordance with company requirements

·       Conducts regular meetings with specified providers to review and improve operational and financial results; clearly communicates Company’s mission and values and operational and clinical imperatives

·       Supports local provider network contracts and provides input about local requirements to corporate contracting

·       Analyzes current and projected network needs from cost/utilization and competitor standpoints; recommends and establishes department metrics and sets clear expectations for staff

·       In conformance with company standards, negotiates, implements, and manages capitated and fee-for-service agreements with individually contracted Primary Care Physicians (PCP), and contract with medical groups, hospitals, ancillary providers and specialists. Administers those contracts to ensure anticipated results

·       In some markets, works with payors to maximize marketing activities, membership growth and retention; identifies, evaluates, and implements business expansion opportunities; interfaces effectively with payor representatives

·       Participates in payor meetings as required and to ensure implementation of and compliance with contracts

·       Escalates local member service issues to centralized member services

·       Works with shared services departments to ensure that local credentialing requirements are met for all clinical professionals

Supervisory Requirements:

Oversees assigned staff which includes Regional Director, Sales. 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:

a.      10+ years of relevant work experience, preferably 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:

    1. Requires a BA/BS
    2. MBA strongly preferred

3.     Other:

a.      Strong knowledge of managed care

b.     Health plan executive leadership

c.      Financial management and oversight

d.     Network relationship knowledge and skills

e.      Must have strong analytical skills and customer service skills

f.      Excellent knowledge of hospitals and managed care finance and contracts

g.     Excellent executive interpersonal and relationship management skills

h.     Strong management skills

i.      Excellent oral, written and presentation skills

j.      Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal

k.     Excellent Microsoft Office skills, including Word and Excel

l.      Experience with delegated and non-delegated providers

m.    Required to travel 25%

4.     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.
  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.

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

State: Arizona

Location City: Remote

Location State: Arizona

Community / Marketing Title: VP, Market President - AZ

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].