Sr. Director, Network Management - Chicago, IL

Job Number: 3168

Workplace Type: Fully Remote

Position Title: Sr. Director, Contracting & Network Mgmt

External Description:

Position Summary:

Reporting to the SVP Network Management, the Senior Director, Network Contracting & Strategy shares responsibility for leading the successful development and execution of contracting strategies and performance initiatives for assigned geographies and health delivery networks.  Working closely with the regional executive teams, s/he will lead the market’s contracting activity to secure quality, cost effective provider networks in support of corporate and market initiatives. 

General Duties/Responsibilities:

(May include but are not limited to)

• Identifies, evaluates, develops and executes contracting and network development strategies in established and new markets that support local market initiatives and corporate goals.
• Negotiates, implements, and manages national agreements, statewide and system contracts, supplemental and vendor contracts, as well as IPA, Hospital and ancillary agreements in local markets in accordance with corporate standards, including network adequacy requirements and performance targets.
• Analyzes current and projected network needs from cost, utilization, performance, network adequacy, competitor and regulatory perspectives to refine network strategy goals for the organization in a proactive and innovative manner.
• Negotiates all compensation methodologies including but not limited to capitation, per diems, case rates and incentive programs.
• Develops new reimbursement models and innovative programs, in concert with leadership, to align incentives with providers and drive optimal performance.
• Conducts contract modeling and analysis in coordination with Finance to align with budgeted trends.
• Oversees administration of the contracts to ensure optimal financial and operational results, identifies outlier performance trends, and develops and implements remediation strategies to restore favorable performance.
• Collaborates with Product Management in the design of supplemental benefit offerings and the financial analysis of the supplement benefits for the CMS bid filing.
• Negotiates and implements national vendor agreements in support of Alignment clinical and operational initiatives.
• Works closely with the SVP Network Management, Senior Medical Officers, Market President and other department leaders to ensure overall success of the market.
• Collaborates with the regional executive team and other departments to ensure the contracted network supports operating goals, including STARS, HEDIS, RAF, member satisfaction and other initiatives.
• Participates in market operating reviews and leads network performance executive meetings with regional and corporate leaders. Collaborates and contributes on the completion of key deliverables to meet and/or exceed budget and operating goals. 
• Develops strong relationships with key provider stakeholders.
• Conducts meetings and JOCs with specified providers to review and improve operational and financial results.
• Oversees the maintenance of all contract templates and the alternative contract language library to ensure contract compliance with regulatory requirements and established corporate policies and procedures. Develops and negotiates contract language consistent with corporate guidelines.
• Manages performance, mentors and develops assigned staff; recruits new staff as needed.
• 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:

1. Minimum Experience:
1. 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.
2. Education/Licensure:
1. Requires a BA/BS; MBA strongly preferred.
3. Other:
1. Strong management skills
2. Strong knowledge of Medicare managed care.
3. Network relationship knowledge and skills.
4. Strong analytical skills
5. Excellent knowledge of hospitals and managed care finance and contracts
6. Excellent executive interpersonal and relationship management skills
7. Excellent oral, written and presentation skills
8. Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal.
9. Excellent Microsoft Office skills, including Word and Excel
10. Experience with delegated and non-delegated providers
11. Ability to travel by car or air
12. 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.

 

1. 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.
2. 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.

City: Chicago

State: Illinois

Location City: Chicago

Location State: Illinois

Community / Marketing Title: Sr. Director, Network Management - Chicago, IL

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].