AVP, Contracting & Network Management

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. 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 Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Reporting to National SVP, Network Strategy & Market Development, the AVP, Contracting & Network Management is responsible for the development of network strategies and leveraging implementation of network development and network management plans to create health care delivery systems that support enhanced marketability, member and provider satisfaction, and company’s overall success. The candidate will work closely with the national business development team, as well as regional and corporate executives and operational teams.

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

• Creates, translates and execute strategies for optimal network and network development in established and new markets.
• In conformance with corporate standards, accountable to lead, manage, negotiate and implement all types of provider network contracts, including but not limited to IPAs/Medical Groups, hospitals, direct network physicians, ancillary providers and supplemental vendors.
• Develops strategy for innovative ways to create value from next gen contracting, network design and care models for government sponsored populations.
• Utilizes financial models to develop and execute strategy for all reimbursement models, including but not limited to capitation, per diems, case rates, value based arrangements and incentive programs to improve quality and efficiency.
• Provides network contracting analysis and contract language expertise to support network management needs for the markets. 
• Leverages the competitive landscape to assess and design network and contracting strategies.
• Works with multidisciplinary team to produce desired growth, financial and operational outcomes.
• Develops strong relationships with key company stakeholders, physician leaders and delivery systems. 
• Works with providers and delivery systems in new and emerging markets to maximize successful new market launches and implementations. 
• Direct others to resolve highly complex or unusual business issues that affect major functions or disciplines.
• Identifies, evaluates and implements network performance opportunities and development activities to support such improvements.
• Works closely with Regional Medical Officers, Market Presidents and other department heads to ensure overall success of the markets. 
• Meets and exceeds budget and operating goals. 
• Establishes department metrics and sets clear expectations for staff and market. 
• Collaborates and supports training and onboarding of new market network leaders to promote adoption of best practices.

Supervisory Responsibilities:

Oversees assigned staff that support the network management needs of the markets. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

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:

  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:

  Must have strong network management and contracting expertise.

  Must possess strong analytical and critical thinking skills.

  Must have ability to develop and implement network strategies.

  Excellent knowledge of managed care, including various reimbursement methodologies and contracting language

  Strong knowledge of managed care

  Demonstrated people leadership skills.

  Excellent oral, written and presentation skills and ability to convey complex or technical information in a manner that is readily understood by others. 

  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

  Experience managing medical cost through network strategies

  Ability to travel nationally 50% of the time

  Available for evenings/weekends and extended work hours as needed

  Outstanding organizational and project management abilities.

  Excellent verbal/written communication; skilled in facilitation and presentation.

• 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].

Pay Range: $172,364.00 - $258,547.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

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].