Director, Preferred Networks & Care Routing

🕒 Março 27

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Alignment Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2013

⚕️ Seguro de Saúde

👥 B2C

💰 $321.050.000 Post-IPO Debt - Alignment Health em 2024-11

Healthcare Insurance • B2C

A Alignment Health é uma empresa de seguros de saúde focada no Medicare, que oferece planos Medicare Advantage e serviços centrados nos membros. Ela oferece acesso a cuidados 24 horas por dia, 7 dias por semana, por meio de canais presenciais, domiciliares e móveis, e dispõe de um cartão sob demanda no estilo concierge para ajudar os membros a agendar consultas, organizar transporte e responder a perguntas de saúde. A Alignment Health faz parcerias com corretores, prestadores de serviços, Organizações de Cuidados Responsáveis (ACOs) e parceiros institucionais, opera em vários estados dos EUA (incluindo Arizona, Califórnia, Nevada, Carolina do Norte e Texas), e recebeu altas classificações do CMS e reconhecimento no setor.

Descrição

• Design and lead the enterprise care routing strategy, aligning provider selection and referral pathways with organizational goals for quality, affordability, access, and member experience. • Define and maintain preferred network frameworks that segment providers based on performance, capacity, access, and clinical outcomes. • Establish clear, data-driven criteria for identifying high-performing providers while ensuring adequate access for members across geographies and specialties. • Evaluate network adequacy beyond regulatory compliance measures, assessing whether the network meaningfully meets member needs related to access, capacity, timeliness, specialty coverage, and care continuity. • Identify gaps, redundancies, or misalignments in the network that may impact care routing effectiveness or member experience. • Partner with Network Management to inform network strategy, provider engagement priorities, and prospective network development. • Design and embed care routing workflows within existing operational teams (e.g., UM, Care Management, Member Services, Provider Relations, Scheduling) to steer members to preferred providers while preserving access and choice. • Influence enterprise decisions related to network design, access standards, clinical programs, and value-based care initiatives using network and performance insights. • Build, lead, and develop a small, high-performing team focused on network intelligence, care routing execution, and network adequacy analysis.

🎯 Requisitos

• 10+ years of experience in healthcare network management, clinical operations, access strategy, or value-based care environments. • 5+ years of leadership experience managing teams or enterprise-level initiatives. • Demonstrated experience evaluating network adequacy, access, or provider capacity beyond regulatory compliance requirements. • Strong understanding of provider performance measurement, referral patterns, access standards, and utilization management. • Proven ability to translate data insights into operational workflows that influence care delivery and member access. • Experience operating effectively in complex, matrixed organizations. • Bachelor's degree required in Healthcare Administration, Public Health, Business Administration, Nursing, or a related field. • Master's degree preferred (e.g., MHA, MPH, MBA, MSN). • Preferred: Lean Six Sigma Black; PMP or Agile certification.

🏖️ Benefícios

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development