Director, Network Management - Alignment Healthcare

Position Summary:

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. Will also oversee third-party vendors and/or student workers as appropriate.

Minimum Requirements:

1. Minimum Experience:
2. 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.
3. Experience with delegated and non-delegated providers
4. Education/Licensure:
5. Requires a BA/BS; MBA preferred.
6. Other:
7. Must have strong analytical skills and customer service skills.
8. Excellent knowledge of hospitals and managed care finance and contracts
9. Strong knowledge of Medicare managed care and associated contract language
10. Excellent interpersonal and relationship management skills
11. Excellent oral, written and presentation skills
12. Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal.
13. Excellent Microsoft Office skills, including Word and Excel
14. Ability to travel by car or air
15. 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.