Network Management Manager (NV Residents Only)

Location: Remote, Nevada US

Notice

This position is no longer open.

Job Number: 3155

Workplace Type: Fully Remote

Position Title: Network Management Manager

External Description:

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

Alignment Healthcare is seeking a network management specialist to assist with building and maintaining high-performance provider networks by identifying opportunities to grow membership, contract with providers, and improve the contractual performance. As a network management specialist, you will work closely with other departments to enhance the contracted provider experience consistent with the company mission statement and values.

 

General Duties/Responsibilities (May include but are not limited to):

·       Responsible for the negotiation of cost effective primary care and specialty care physician, and ancillary contracts,  and maintenance of AHP networks on an ongoing basis and as requested by the Regional Markets

 

·       Provide direct physician and ancillary contracting guidance and function as the subject matter expert in direct physician and ancillary contacting for all Markets

 

·       Act as the technical resource on provider relations issues related to physician and ancillary contracts. Responsible for timely and professional interaction with internal and external customers.

 

·       As requested, assist with the negotiation of provider letters of agreements.

 

·       Enhances the relationship with providers by  providing, appropriate data sharing, by efficiently and effectively responding to requests for information, and by successfully resolving issues related to capitation, claims, and other operational functions.

 

·       Utilizes understanding of the business risk relationships to interact and influence primary care and specialty care physicians, and ancillary provdiers and identify key types of contracts that need to be negotiated.

 

·       Maintains timely internal awareness of network changes by issuing timely and accurate provider update communications about contractual arrangement changes, provider terminations, changes and additions.

 

·       Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes.

 

·       Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of terminations. 

 

·       Contribute to team effort by accomplishing related results as needed.

 

·       Other duties as assigned

Supervisory Responsibilities:

N/A

 

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

·       Minimum Experience:

o   Minimum 5 years’ experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required

·       Education/Licensure:

o   Bachelor’s Degree preferred.

·       Other:

o   Strong analytic, quantitative, and problem-solving skills required.

o   Strong verbal and written communication skills required.

o   Strong presentation skills and ability to appropriately and effectively address diverse audiences required.

o   Proficiency in MS Word and Excel required; Access database proficiency preferred.

o   Work Conditions:

                                                               i.      Office Hours:  Monday-Friday, 8am to 5pm.  Extended work hours, as needed.

                                                             ii.      20-60% or more travel by car routinely required for Specialists.

                                                           iii.      Travel by plan required as needed to support provider services needs in other geographies.

                                                           iv.      Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.

  • 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.

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.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected]

City: Remote

State: Nevada

Location City: Remote

Location State: Nevada

Community / Marketing Title: Network Management Manager (NV Residents Only)

Company Profile:

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