Regional Medical Director, Health Plan

Alignment Health

. Serve as physician leader supporting performance across assigned markets and provider networks .

Posted 10/7/2026full-timeOrange • California • United StatesLead💰 $262,145 - $393,217 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managed care operations, Medicare Advantage, and value-based care, with a strong focus on quality improvement, risk adjustment, and performance metrics. Proven ability to analyze complex data and lead provider relationships to enhance care coordination and member experience.

Highest-signal resume keywords

MD Or DO DegreeBoard Certification In ABMS Or AOA SpecialtyActive Medical License In CaliforniaLeadership Experience In Managed CareAdvanced Knowledge Of Medicare Advantage Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Practice ExperienceUtilization ManagementRisk AdjustmentQuality ImprovementData AnalysisPerformance Metrics InterpretationCare CoordinationPopulation Health ManagementValue-Based Care PerformanceDocumentation Accuracy

Soft Skills

Excellent Written CommunicationVerbal CommunicationPresentation SkillsRelationship ManagementAbility To Operate In Matrixed Environments

Certifications & Qualifications

Board Certification In ABMS Or AOA SpecialtyActive Medical License In California

Industry Keywords

Medicare AdvantageCMS Regulatory RequirementsHEDISCAHPSHOSStars ProgramManaged Care PrinciplesProvider NetworksPerformance ReviewsMarket Dynamics

About the role

Key responsibilities & impact

Serve as physician leader supporting performance across assigned markets and provider networks
Maintain understanding of local provider landscapes, referral patterns, market dynamics, and operational challenges
Build provider relationships around managed care, population health, quality improvement, and value-based care
Partner with Network Management and providers to improve quality, affordability, risk adjustment, Stars, member experience, and value-based care performance
Lead provider-facing discussions, performance reviews, and action planning
Advise provider groups, IPAs, health systems, and internal stakeholders
Analyze clinical, operational, financial, utilization, and quality data to identify performance gaps
Develop and support market-specific strategies improving MLR, utilization, quality, care coordination, and population health
Implement evidence-based interventions with providers and provider organizations
Monitor performance against goals and adjust strategies
Improve documentation accuracy, risk adjustment, chronic disease management, and preventive care outcomes
Support Stars, HEDIS, CAHPS, HOS, medication adherence, and care gap closure initiatives
Collaborate with Network Management, Risk Adjustment, Quality, Pharmacy, Care Management, Utilization Management, Analytics, and Operations teams
Participate in committees, workgroups, and strategic initiatives
Maintain knowledge of Medicare Advantage, CMS, and applicable regulatory requirements
Travel throughout local markets for provider meetings, performance reviews, operational initiatives, and relationship management

Requirements

What you’ll need

Minimum 5 years of clinical practice experience
Minimum 3–5 years of leadership experience within managed care, Medicare Advantage, physician organizations, IPA/MSO, or value-based care environments
MD or DO degree from an accredited institution
Board certification in an ABMS or AOA-recognized specialty
Active, unrestricted medical license in California
Working knowledge of Medicare Advantage operations, managed care principles, and CMS regulatory requirements
Advanced knowledge of Medicare Advantage and managed care operations, utilization management, risk adjustment, Stars, HEDIS, and value-based care performance metrics
Ability to interpret complex clinical, financial, and quality performance data
Demonstrated experience working with physicians, provider groups, and executive stakeholders
Working knowledge of utilization trends, site-of-service optimization, readmission drivers, and medical expense management
Knowledge of HEDIS, CAHPS, HOS, and Stars program requirements
Excellent written, verbal, and presentation skills
Proven ability to operate effectively in matrixed environments
Must reside in Orange County, California
Ability to travel throughout local markets and occasionally to the corporate office and other organizational meetings or events

Benefits

Comp & perks

Hybrid remote work arrangement
Professional growth and innovation opportunities
Equal opportunity employment