Network Management Director

3 weeks ago

Orange, California, United States Alignment Healthcare USA, LLC Full time
Job Summary:

The Network Management Manager is responsible for contracting with all provider types and ensuring successful provider network performance related to key financial, operational, and member satisfaction performance indicators. This role works closely with other departments to enhance the contracted provider experience consistent with the company's mission statement and values.

Key Responsibilities:

• Develop and implement strategies to improve provider network performance and satisfaction.
• Negotiate and finalize all assigned contracts, ensuring accuracy and compliance with company requirements.
• Develop provider education materials to support adherence with company standards and expectations.
• Lead Joint Operations Meetings to drive results and address performance improvement metrics.
• Oversee physician adds and successful completion of physician credentialing and NOC process.
• Provide technical support on provider relations issues and offer collaborative leadership internally and externally.
• Ensure accurate and timely data reporting requirements are met for designated regions.
• Develop goals and objectives that align with Network Management leadership's performance metrics.

Requirements:

• Minimum 5-7 years' experience with an HMO, managed care provider organization, or insurance company with at least 3 years' specific experience in managed care contracting and knowledge of Medicare Advantage regulatory guidelines.
• Proficient in MS Office, including strong Word and Excel proficiency.
• Bachelor's Degree or equivalent experience required.

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.

This role requires regular interaction with internal and external customers, including providers and employees of internal/external organizations. The employee regularly is required to talk or hear, 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.

Pay Range:
$85,000 - $95,000 annually.

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