Alignment Health · 10 hours ago
Director, Network Management
North Carolina, United States
Full-time
Onsite
Director/Executive
$110K/yr - $165K/yr
10+ years expAlignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. The Director, Network Management, is responsible for meeting the network management needs for assigned geography and/or health delivery networks, ensuring quality performance goals and overseeing regional performance of the network.
Health CareHospitalMedicalMedical DeviceWellness
Responsibilities
Leads and facilitates join operations committee meetings (JOC) with MSO, IPA and Direct Ancillary contracted providers
Leads and manages 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
Reviews, analyzes and develops 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)
Trains and manages 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
Collaborates 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
Qualification
Required
Minimum 10 years of experience in managed care or health care field, with a solid 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
Minimum 5 years of experience with delegated and non-delegated providers
Minimum 2 years of supervisory experience
High School Diploma or GED
Bachelor's degree or four years additional experience in lieu of education
Excellent knowledge of hospitals and managed care finance and contracts
Solid knowledge of Medicare managed care and associated contract language
Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal
Excellent Microsoft Office skills, including Word and Excel
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment
Report Analysis Skills: Comprehend and analyze statistical reports
Ability to travel by car or air
Available for evenings/weekends and extended work hours as needed
Preferred
5 years of supervisory experience
MBA
Company
Alignment Health
Alignment Health provides eldercare services.
501-1000 employees
H1B Sponsorship
Alignment Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (12)
2023 (17)
2022 (13)
2021 (11)
2020 (6)
Funding
Current Stage
Public CompanyTotal Funding
$696.05MKey Investors
K2 HealthVenturesWarburg PincusGeneral Atlantic
2024-11-15Post Ipo Debt· $321.05M
2024-01-09Private Equity
2021-03-26IPO
Leadership Team
Dawn Maroney
President, Markets & CEO of Alignment Health Plan
John Kao
CEO and Founder
Recent News
Company data provided by crunchbase