Senior Manager

Description:

Alignment Health, a mission-driven healthcare company dedicated to transforming care for seniors and chronically ill patients, is hiring a Senior Manager of Network Management in Texas. This position plays a pivotal role in contracting with providers and ensuring strong provider network performance aligned with financial, operational, and member satisfaction goals. The Senior Manager will work closely with leadership and internal teams to optimize provider relationships, resolve operational challenges, and strengthen the Medicare Advantage provider network across multiple markets.

Key Responsibilities:

• Contracting & Network Development: Lead contracting strategy, recruit providers, negotiate and finalize contracts (primary care, specialists, ancillary, hospital, IPA/group).

• Performance Oversight: Monitor provider network performance across financial, operational, and satisfaction metrics.

• Provider Engagement: Develop agendas and lead Joint Operations Meetings, oversee new provider onboarding and orientations, and deliver education materials.

• Operational Management: Address issues such as utilization management, claims, grievances, continuity of care, risk sharing, and audit compliance.

• Staff Leadership: Manage, mentor, and evaluate staff; oversee workload assignments and training.

• Data & Reporting: Ensure accurate reporting on eligibility, capitation, utilization, claims timeliness, pharmacy usage, and audit requirements.

• Collaboration & Compliance: Partner across departments, resolve provider issues, ensure compliance with Medicare Advantage regulations, and represent the department in interdepartmental meetings.

• Problem Solving: Research and resolve complex contracting, eligibility, and claims-related problems.

• Policy & Strategy: Create and implement departmental policies and align goals with organizational KPIs for network growth.

Qualifications:

• Education: Bachelor’s degree (or equivalent experience) required.

• Experience:

  • 5–7 years’ managed care and contracting experience.

  • Prior supervisory experience managing teams.

  • Strong knowledge of Medicare Advantage guidelines and regulatory requirements.

• Skills:

  • Proficient in MS Office (Excel and Word required).

  • Strong analytical, mathematical, and problem-solving skills.

  • Excellent communication, negotiation, and presentation abilities.

  • Ability to interpret complex contracts and government regulations.

• Other Requirements:

  • Reliable transportation, valid driver’s license, and insurance.

  • Travel: approximately 20–40% of time.

  • Ability to lift up to 10 lbs; standard office hours (Monday–Friday, 8 AM–5 PM, with extended hours as needed).

Compensation & Benefits:

• Salary: $91,651 – $137,477 annually ($7,638 – $11,456 monthly).

• Comprehensive benefits package (health, dental, vision, retirement, PTO, etc.).

• Equal Employment Opportunity and Affirmative Action employer.