Director, Preferred Networks – Care Routing

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Alignment Health

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2013

⚕️ Krankenversicherung

💰 €135.000.000 Series C im 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health engagiert sich für die Bereitstellung umfassender Pflege für Medicare-Mitglieder, wobei der Fokus auf den Bedürfnissen von Senioren, chronisch Kranken und gebrechlichen Personen liegt. Mit der Mission, das Gesundheitswesen für Senioren zu transformieren, nutzt Alignment Health ein maßgeschneidertes Pflegemodell und fortschrittliche Technologie, um qualitativ hochwertige, kostengünstige Gesundheitsdienstleistungen anzubieten. Ihr 24/7-Konzierge-Pflegeteam arbeitet mit vertrauenswürdigen lokalen Anbietern zusammen, um sicherzustellen, dass jedes Mitglied eine individuelle Betreuung erhält, was das Engagement des Unternehmens widerspiegelt, alle Mitglieder als geschätzte Familienmitglieder zu behandeln.

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. • Own the development of network intelligence capabilities that integrate claims, utilization, clinical outcomes, access, and member demand data. • 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. • Provide data-driven recommendations to adjust network composition, provider mix, or geographic coverage based on performance and access insights. • 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. • 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. • Required: Deep understanding of healthcare provider networks, network adequacy, access standards, and care delivery models. • Strong analytical skills with the ability to synthesize access, utilization, and performance data into actionable strategies. • Ability to balance member access, provider performance, and operational feasibility in care routing decisions. • Strong communication and executive presence, with the ability to influence clinical, operational, and network stakeholders. • Experience designing and operationalizing workflows across clinical and non-clinical teams.

🏖️ Vorteile

• None