Jobs at Alignment Healthcare

Leads health plan provider enrollment operations, including contract implementation, provider onboarding, delegated credentialing roster management, non-participating provider administration, data governance, compliance, audits, and process improvement. Oversees provider setup across operational systems, ensures regulatory and directory accuracy, manages performance metrics and vendors, and leads enrollment teams supporting network growth and claims readiness.

Develop member-level predictive models and longitudinal analyses for CMS Health Outcomes Survey measures and Medicare Advantage Star Ratings. Analyze survey drivers, trajectories, sampling, response rates, case-mix adjustments, and statistical significance. Build data pipelines and dashboards, validate methodologies, deploy models with engineering teams, and translate findings into clinical and operational interventions. Collaborate with Stars, clinical, care management, compliance, legal, and survey vendor stakeholders to ensure CMS-aligned outcomes and reporting.

Leads the enterprise AI and automation strategy for a Medicare Advantage business. Designs and scales production AI/ML, generative AI, RPA, workflow orchestration, and MLOps capabilities across claims, clinical operations, finance, and member services. Owns platform selection, governance, compliance, budgets, vendors, and ROI measurement while ensuring responsible AI practices meet CMS, HIPAA, privacy, and security standards. Provides technical leadership and executive communication without direct people-management responsibility.

Provides remote telephonic case management for medically complex and chronically ill Special Needs Plan members. Conducts health assessments, develops individualized care plans, coordinates with physicians and specialists, educates members and caregivers, monitors progress, advocates for interventions, and resolves care access issues. Requires an active California RN license, clinical nursing and case management experience, and Microsoft Office proficiency.

Leads enterprise process improvement and operational excellence across a Medicare Advantage organization. The role identifies inefficiencies, redesigns workflows, drives cross-functional transformation initiatives, establishes KPIs and dashboards, quantifies outcomes, and advises leadership. It also builds and manages a team responsible for program management, business analysis, process improvement, and transformation delivery.

Leads enterprise transformation, strategic planning, capital investment governance, portfolio management, process improvement, and total cost of care initiatives for a Medicare Advantage health plan. Partners with executives to align investments, improve operational performance, reduce costs, enhance member and provider experiences, support regulatory readiness, and drive organizational change. Builds and leads teams responsible for strategy execution, program management, business analysis, and transformation delivery.

Leads the architecture, development, deployment, and operation of production AI, distributed systems, cloud infrastructure, automation, and data platforms. Integrates AI/ML models and LLMs into healthcare workflows, builds Databricks pipelines, governs RPA and ETL reliability, and establishes CI/CD, monitoring, security, and responsible AI standards. Mentors engineers, leads technical design and incident reviews, and partners across AI, data, product, clinical operations, and application engineering teams.

Build and deploy production AI/ML systems, distributed services, integrations, automation pipelines, and MLOps infrastructure in a regulated healthcare environment. Responsibilities include cloud-native architecture, legacy and multimodal data integration, Docker and Kubernetes deployment, ETL orchestration, RPA, LLM and RAG workflows, Databricks model productionization, monitoring, cost optimization, and responsible AI practices. Collaborate with AI, data, product, clinical, and engineering teams.

Designs and governs enterprise data architecture for a Medicare Advantage health plan. Builds data models and integrations supporting claims, EHRs, risk adjustment, HEDIS, Star ratings, CMS reporting, analytics, and AI/ML. Establishes governance, security, privacy, lineage, and data quality frameworks for regulated PHI/PII environments. Evaluates cloud platforms and vendors, leads cross-functional architecture initiatives, and advances capabilities such as FHIR interoperability, generative AI, and real-time streaming.

Conducts risk-based Utilization Management and Case Management audits of delegated healthcare entities. Evaluates CMS, contractual, and organizational compliance; communicates findings; identifies root causes and risks; validates corrective action plans; maintains audit-ready documentation; prepares reports and dashboards; and collaborates with clinical, quality, compliance, and operational stakeholders. Requires an active LVN or RN license and supports regulatory and accreditation readiness.

Designs, develops, implements, and supports business technology solutions, including workflows, applications, integrations, data models, reporting tools, and automation. Partners with business teams to gather requirements, improve processes, build scalable solutions, manage deployments, provide production support, and ensure security, governance, documentation, and user adoption. Requires expertise in business systems, workflow platforms, SQL, APIs, integrations, testing, and solution lifecycle management.

Develop predictive models, customer segmentation, automated data pipelines, and analytics supporting CAHPS, HOS, and Medicare Advantage Stars strategy. Collaborate with engineering, clinical, compliance, coding, and legal teams to ensure CMS-aligned outputs. Analyze complex healthcare data, communicate insights to stakeholders, support dashboards and reporting, and help standardize AI-readiness workflows. The role requires advanced machine learning, programming, statistical analysis, and healthcare quality modeling expertise.

Build predictive models, forecasting and simulation tools for pharmacy and Medicare Part D Star measures. Partner with pharmacy leadership to develop actionable analytics, dashboards, prioritization rules and next-best-action logic. Analyze financial impacts, deploy and monitor production-ready models, and collaborate with engineering teams on versioning, testing and CI/CD. Standardize data definitions and reporting workflows while incorporating new data sources and analytical techniques.

Leads strategic growth for Alignment Health’s Care Delivery Organization across Nevada, Texas, Arizona, and North Carolina. Owns membership growth, enrollment, attribution, AEP readiness, market expansion, growth analytics, ROI optimization, budgeting, and physician-group activation. Partners with provider contracting and market leadership to execute multi-market growth strategies, while managing and developing the CDO Strategic Growth team.

Leads enterprise transformation of provider operations across claims, credentialing, provider data, prior authorization, contracting, delegation oversight, and provider services. Defines strategy, operating models, process improvements, technology priorities, KPIs, business cases, and governance. Partners with executives and cross-functional teams to implement automation, AI-enabled capabilities, digital workflows, and scalable processes that improve efficiency, compliance, provider experience, and measurable business outcomes.

Leads enterprise-wide capital planning, investment governance, strategic resource allocation, portfolio management, and investment performance evaluation for a Medicare Advantage health plan. Partners with executive leadership and Finance, IT, Operations, Clinical, Compliance, and PMO teams to prioritize investments, assess ROI, manage forecasts, support transformation and expansion initiatives, and report to executives and the Board. Builds and leads the Capital Planning Office.

Provides compassionate, end-to-end support to health plan members, primarily older adults and individuals with disabilities. Responds to benefit, eligibility, provider network, claims, reimbursement, and service inquiries; resolves complaints and grievances; documents interactions accurately; and supports outreach programs. The role requires managing complex contacts, navigating multiple systems, maintaining HIPAA confidentiality, meeting service-level and performance standards, and delivering clear, empathetic communication in a remote environment.

Leads data analysis and data operations for a Medicare Advantage health plan. Defines data requirements, improves quality across claims, membership, and provider domains, resolves production issues, and ensures healthcare interoperability using EDI and related standards. Partners with clinical, actuarial, operational, and technology teams to support trusted analytics and regulatory needs. Directs and mentors the data analysis team while enabling cloud-based data platforms, automation, and continuous improvement.

Generates new health plan enrollments and retains existing members through inbound and outbound telephone interactions. Handles inquiries from prospective members, providers, and community partners; directs prospects to field sales when appropriate; conducts enrollment and disenrollment campaigns; submits activity reports; follows CMS, federal, state, and company marketing guidelines; supports competitor analysis and Sales and Marketing projects.

Leads analytics strategy, reporting, and data product delivery while managing an analytics team and portfolio. Designs scalable solutions, performs complex analysis, validates data, resolves issues, and provides executive reporting. Establishes analytics standards, roadmaps, prioritization, and operating processes; partners across operations, clinical, finance, compliance, and technology. The role improves insight quality and speed, reduces manual work, strengthens data trust, and supports business decision-making.