Director, Contracting and Network Management

Job Number: 7616

Workplace Type: Hybrid Remote

Position Title: Director, Contract Network Management

External Description

Reporting to VP of Network, the Director, Contracting and Network Management is responsible for leading the development and execution of contracting strategies for assigned geographies and health delivery networks. Working closely with the regional executive teams, s/he will lead the market’s contracting activity that secures a quality, cost-effective provider network of healthcare services consistent with corporate guidelines and requirements.

General Duties/Responsibilities

(May include but are not limited to)

• Identifies, evaluates and executes contracting and network development strategies in established and new markets.
• In conformance with corporate standards, including network adequacy requirements and performance targets, negotiates, implements, and manages capitated and fee-for-service agreements with individually contracted Primary Care Physicians (PCP), medical groups, hospitals, integrated delivery systems, ancillary providers and specialists.
• Analyzes current and projected network needs from cost/utilization and competitor standpoints for decision making purposes.
• Negotiates all compensation methodologies including but not limited to capitation, per diems, case rates and incentive programs. Develops new reimbursement models in concert with leadership.
• Conducts contract modeling and analysis in coordination with Finance.
• Analyzes, negotiates, and drafts contract rate and language proposals consistent with corporate guidelines for language, financial and operational performance.
• Oversees administration of the contracts to ensure anticipated results, identify negative performance trends, and implement cost containment and other improvement strategies.
• Works closely with VP of Network, Regional Medical Officers, Market President and other departments to ensure overall success of the market.
• Collaborate with regional executive team and other departments to ensure contracted network support of operating goals, including STARS, HEDIS, RAF, and other initiatives.
• Participates in monthly market review meetings with regional and corporate leaders.
• Develops strong relationships with key provider stakeholders.
• Oversees the maintenance of all contract templates to ensure contract compliance with regulatory requirements and established policies and procedures.
• Oversees assigned staff; recruits, develops and manages performance.
• Recommends and establishes department metrics. Sets goals for staff and the market.
• 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; coaching, counseling, and disciplining employees.

Minimum Requirements

• Minimum Experience:
• 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.
• Education/Licensure:
• Requires a BA/BS; MBA strongly preferred.
• Other:
• Strong knowledge of Medicare managed care.
• IPA experience preferred.
• Proficient with contractual provisions and structure for specific provider type (e.g. hospital, ancillary, physician)
• Network relationship knowledge and skills.
• Must have strong analytical skills
• Excellent executive interpersonal and relationship management skills
• Strong management skills.
• Excellent oral, written and presentation skills
• 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
• Experience with delegated and non-delegated providers
• Ability to travel by car or air
• Available for evenings/weekends and extended work hours as needed
  

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.
  
  

Pay Range: $110,000 - $150,000 annually.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Director, Contracting and Network Management

Company Profile

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! 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 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].