Director, Preferred Networks & Care Routing

🕒 vor 2 Monaten

Jetzt Bewerben

Ähnliche Remote-Jobs finden

E-Mails für Remote-Jobs erhalten

📊 Überprüfen Sie Ihre Lebenslauf-Bewertung für diese Stelle

Verbessern Sie Ihre Chancen auf ein Vorstellungsgespräch, indem Sie Ihre Lebenslauf-Bewertung vor der Bewerbung überprüfen.

Lebenslauf hochladen

Alignment Health

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2013

⚕️ Krankenversicherung

👥 B2C

💰 €321.050.000 Post-IPO Debt - Alignment Health im 2024-11

Healthcare Insurance • B2C

Alignment Health ist ein auf Medicare fokussiertes Krankenversicherungsunternehmen, das Medicare Advantage-Pläne und mitgliederzentrierte Dienstleistungen anbietet. Es bietet rund um die Uhr an sieben Tagen der Woche Zugang zu Pflegeleistungen über persönliche, häusliche und mobile Kanäle und bietet eine Concierge-Karte auf Abruf, die Mitgliedern hilft, Termine zu vereinbaren, Transportmittel zu organisieren und Gesundheitsfragen zu beantworten. Alignment Health arbeitet mit Vermittlern, Anbietern, Accountable Care Organizations (ACOs) und institutionellen Partnern zusammen, ist in mehreren US-Bundesstaaten tätig (darunter Arizona, Kalifornien, Nevada, North Carolina und Texas) und hat hohe CMS-Bewertungen und Anerkennung in der Branche erhalten.

Beschreibung

• 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.

🎯 Anforderungen

• 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.

🏖️ Vorteile

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