Senior Director, Care Delivery Org – Value Based Care Contracting

Job not on LinkedIn

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $149.9k - $224.8k / year

⏰ Full Time

🟠 Senior

👔 Director

👻 Ghost score 0%

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Develop and execute value-based contracting strategy aligned with total cost and quality goals • Design alternative payment models and negotiate high-value contracts with IPAs, large physician groups, health systems, and other provider entities • Own the full contracting cycle from planning and document creation through negotiation, execution, and submission for loading • Lead negotiations for complex provider contracts and facilitate external provider meetings • Align negotiation strategy with network accessibility, quality, compliance, and financial performance goals • Develop value-based strategic plans and oversee contract performance with targeted provider groups • Evaluate and implement network strategic plans to achieve contracting targets and manage medical costs • Review medical claims data, analyze cost trends, and prepare executive summaries • Model risk-based contract scenarios and support business cases for contract structures and cost improvement initiatives • Build, lead, and manage the MSO Contracting team • Recruit, onboard, coach, manage performance, and retain contracting staff • Coordinate contract support with HEDIS, Credentialing, Grievance & Appeals, SIU, and Member Services • Lead complex, multi-stakeholder contracting projects from assessment through implementation • Ensure project milestones, stakeholder alignment, and deliverables are completed on schedule

🎯 Requirements

• Minimum 10 years of related experience in value-based contract negotiation within a managed care, Medicare Advantage, or healthcare services environment • Demonstrated track record negotiating value-based contracts with IPAs, large complex provider systems, hospitals, and large physician entities • Expert-level negotiating skills, including full-risk, shared savings, capitation, and alternative payment models • Experience reviewing medical claims data and developing executive summaries to mitigate medical cost trends • Proven ability to work in a matrixed organization and drive cross-functional alignment • Experience managing the complete contracting cycle from strategy and planning through execution and contract loading • Bachelor's degree in Healthcare Administration, Business, Finance, or a related field; equivalent combination of professional work experience and education will be considered • Demonstrated working knowledge of value-based care models, alternative payment methodologies, and Medicare Advantage contracting frameworks through applied experience • Advanced value-based contract negotiation skills • Advanced medical claims and financial data analysis skills • Advanced alternative payment model design and strategy knowledge • Advanced network strategy and provider relationship management skills • Advanced cross-functional influence and stakeholder alignment skills • Intermediate to advanced CMS Stars and HEDIS knowledge • Advanced project and program leadership skills

🏖️ Benefits

• Fully remote work • Equal Opportunity/Affirmative Action employment • Reasonable accommodations for individuals with disabilities