Director, Contracting and Network Management

Location: Remote-US, California US


This position is no longer open.

Job Number: 4160

Workplace Type: Fully Remote

Position Title: Director, Contract Network Management

External Description:

Position Summary:

The Director, Contracting and Network Management is responsible for meeting the contracting and network management needs for assigned geography and/or 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 and outcomes 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 IPAs, medical groups, hospitals, integrated delivery systems, direct network physicians, ancillary providers and supplemental providers/vendors.
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 incentives and value based 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 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 all Network Management Directors and Vice Presidents, Regional Medical Officers, Market Presidents 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 market review meetings with regional and corporate leaders to review and improve operational and financial results.

· 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 any required contract amendments and resolves contract issues.
· 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.
Performs other position duties as assigned.
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 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:

a. 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:

a. Requires a BA/BS; MBA strongly preferred.

· Other:

a. Strong knowledge of Medicare managed care

b. Network relationship knowledge and skills

Must have strong analytical skills
Excellent knowledge of hospitals, managed care finance and contract language
Excellent 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.
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.

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Director, Contracting and Network Management

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 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].