Network Management Specialist

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most : the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Network Management Specialist will assist in building and maintaining high-performance provider networks by identifying opportunities to contract with providers and improve the contractual performance. Works closely with other departments to enhance the contracted provider experience consistent with company's mission statement and values.

May include but are not limited to)

• Recruits new providers.
• Prepares supporting documentation, negotiates and implements contracts for physicians and ancillary providers for existing and developing markets.
• Acts as technical resource on provider relations issues. Responsible for timely and professional interaction with internal and external customers.
• Utilizes understanding of the business risk relationships to interact and influence key physician leaders.
• Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures.
• Ensures overall compliance by responding to grievances / appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes.
• Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of terminations and / or provider changes.
• Supports department efforts and Network Management by participating in interdepartmental meetings and selected committees.
• Contributes to team effort by accomplishing related results as needed.

Minimum Requirements :

Minimum Experience :

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Pay Range : $64,384.00 - $96,577.00

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.

Salary : $64,384 - $96,577