Director of Network Optimization

6 days ago


San Jose, California, United States Alignment Healthcare LLC Full time

About Alignment Healthcare

We are a healthcare company dedicated to transforming the delivery of care for Medicare and Medicaid patients. Our mission is to deliver high-quality, cost-effective healthcare services that improve health outcomes and patient satisfaction.

Job Summary

We are seeking an experienced Director of Network Optimization to join our team. In this role, you will be responsible for developing and executing strategies to optimize our network of providers, ensuring we have the right partners in place to deliver high-quality care to our patients.

About the Role

The Sr. Director, Network Management will lead the development, growth, and performance of our assigned geography and/or health delivery networks. This includes working closely with regional executive teams to drive clinical performance, growth, CAHPS, MRA, and STARS measures, and producing outcomes consistent with corporate guidelines and requirements.

You will offer technical leadership and expertise to both regional and corporate initiatives for physician, hospital, and ancillary contracted networks. This includes direct communication to improve quality performance goals with IPA and Hospitals. You will also oversee the regional performance of our network.

Main Responsibilities

Develop and execute strategies for optimal network and network development in established and new markets.Leverage the competitive landscape to assess and design network and contracting strategies.Work with multidisciplinary teams to produce desired growth, financial, and operational outcomes.Collaborate with regional executive teams and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, MRA, and other initiatives.Work closely with Regional Medical Officers and collaborate with other departments to ensure overall success of the market. Meet and exceed budget and operating goals.Identify and contract with new PCPs and specialists to develop the network.Analyze current and projected network needs from cost/utilization and competitor standpoints.Partner with Contracting to analyze and negotiate contract rate and language proposals.Develop strong relationships with key external stakeholders, physician leaders, network physicians, hospitals, and ancillary providers.Partner with Sales and Member Experience teams to develop and execute growth and retention plans.Lead and manage IPA market management resources to ensure execution of operating, performance, and growth initiatives.Lead and manage Provider Service Representatives to maximize engagement through consistent face-to-face interactions, in-service visits, training sessions, and outcome reviews.Weekly status update to Regional VP - Track and report network performance and opportunities for assigned regions.Contribute expertise to development of organizational best practices.

Requirements

To be successful in this role, you will need:

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

Salary and Benefits

Our salary range for this position is $120,000 - $160,000 per year, depending on experience. We also offer a comprehensive benefits package, including medical, dental, and vision insurance, 401(k) matching, and paid time off.

Location

This position is based in Orange County, California. We require occasional travel to meet with clients and partners.



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