Director, Network Operations

Location: Remote-US, California US

Notice

This position is no longer open.

Job Number: 3901

Workplace Type: Fully Remote

Position Title: Director, Network Operations

External Description:

Position Summary:

Reporting to the VP, Provider Operations & Services, the Director, Provider Operations is responsible for leading strategic initiatives focused on provider and network operations, including (but not limited to) policy and procedure development, KPI and reporting definition and design, network and market business rules, quarterly provider roster validation, operationalization of new provider groups, identification, design and build of new processes and tools, and compliance / regulatory analyses and action plan development. This role requires comfort working with ambiguity, and the ability to proactively define, lead and execute initiatives in a highly collaborative environment. The role also requires outstanding communication and organizational skills, and the ability to direct cross-functional initiatives and teams in a dynamic, fast-paced environment.

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

· Partners with Provider Operations team leadership (across all areas of the organization) to define and execute strategic performance improvement initiatives

· Consistently and proactively identifies opportunities for capability enhancements (people, process and technology) and leads strategies and approaches to implement them

· For defined strategic initiatives, leads process improvement and / or requirement gathering activities, serving in a principal business analyst capacity. Ensures initiatives are clearly articulated and that cross-functional teams understand requirements and critical path to effectively execute.

· Prepares / oversees preparation of process and requirements documentation and effectively communicates the details to appropriate audiences (Operations, Claims, IT, Provider Data Management, Network Management, eternal vendors, etc.)

· Initiates and leads internal and strategic projects aimed at delivering capability and process improvements

· Leads development and implementation of market and network business rules, ensuring rules are successfully configured and executed within Alignment’s internal systems and processes

· Translates complex and nuanced provider contract terms into actionable detail required for operationalization, reporting and provider service

· Leads process development, execution and tracking of quarterly provider directory validation initiatives to ensure that provider demographic data is complete and accurate, provider roster validation is conducted timely and that Alignment’s provider directories are accurate and compliant with CMS requirements.

· Drives activities cross-functional initiatives to continuously improve the provider roster validation process, develops and executes strategies to improve provider responsiveness to data validation requests and Alignment brand awareness

· Leads efforts to define, document and clearly communicate policies, procedures, and workflows to ensure that Provider Operations processes are clear and that teams execute them consistent with Alignment’s business, operational and regulatory requirements

· Oversees cross-functional work teams to manages annual updates to the externally-facing Provider Operations Manual and serves as a key subject matter expert on policies and procedures for the enterprise

· Leads and / or supports internal reporting function to ensure reports, dashboards and metrics are relevant meaningful, accurate and timely

· Partners with Provider Operations leadership develop key internal communications, including business case documentation, executive presentations, initiative updates, KPI reporting, testing and validation outcomes, etc.

· Develops and delivers internal training and communications to Provider Operations teams as well as other internal Alignment teams and partners

· Leads development and execution of project plans: Using a variety of tools (xl, internal tracking and ticketing tools):

a. Sets targets for milestones

b. Develops tracking

c. Serve as a point of contact for internal teams to ensure operational synergy.

d. Communicating project statuses and risks to leadership.

e. Performing quality control throughout project development.

f. Evaluating and adjusting target dates on projects as needed.

· Partners with Provider Operations leadership in developing internal department KPIs and driving internal processes and tools to enable consistent reporting and monitoring of them

Supervisory responsibilities:

Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and providing frequent performance feedback.

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.


1. Minimum Experience:

a. 7-10 years in healthcare or managed care operations, preferably in a Network Management / Provider Relations or Provider Data Management department

b. 3-5 years experience leading cross-functional performance improvement initiatives; strong ability to execute and drive consensus and build partnerships across the enterprise

c. Strong working knowledge of health care back-office functions

2. Education/Licensure:

a. Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience

3. Other:

a. Ability to comfortably interact with and drive initiatives collaboratively with leaders at all levels throughout the organization

b. Outstanding project management and organizational skills

c. Ability to define future-state capability sets and identify gaps between current and future-state needs

d. Experience leading process improvement initiatives in a complex technical and operational environment

e. Intermediate to Advanced experience and skills with Microsoft Office Products. Strong knowledge of Excel (Pivot tables, VLOOKUP’s, Macros)

f. Ability to translate data into insights; and use those insights to drive outcomes-focused decisions

g. Ability to translate strategic intent to tactical execution plans

h. Articulate & persuasive in presenting business-case for change management, where required

i. Experience with Access Database and SalesForce is a plus

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.

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Director, Network Operations

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].