Alignment Health

Systems Engineer

• Partner with business and operational teams to understand processes, identify gaps, and define business requirements
• Analyze operational challenges and develop solution recommendations
• Determine whether needs are best addressed through process improvements, technology solutions, data structures, reporting capabilities, or workflow automation
• Prioritize initiatives based on business value, risk, complexity, and resource requirements
• Define success measures and expected outcomes
• Design, configure, develop, test, deploy, and maintain business solutions
• Develop prototypes and convert approved concepts into production-ready solutions
• Create and maintain technical and functional documentation
• Manage solutions throughout their lifecycle, including enhancements and issue resolution
• Ensure solutions meet security, supportability, and governance requirements
• Develop workflows, forms, routing processes, approvals, and case management solutions
• Build integrations between systems, applications, and data sources using APIs, connectors, and scripting tools
• Design data models, validation controls, and information structures
• Establish standards, templates, and reusable components
• Support user testing, implementation, training, and change management
• Provide production support and troubleshoot issues
• Monitor solution performance and recommend enhancements
• Measure and report operational outcomes and business value
• Communicate project status, risks, issues, and results to stakeholders
• Work cross-functionally with business unit leaders as an individual contributor

Senior Business Systems Engineer

Data Scientist

• Collaborate with business leaders to understand business problems and develop analytical solutions
• Apply coding skills and data structures knowledge to develop projects with scientists and engineers
• Build customer segmentation models to understand customers and tailor clinical outcomes and healthcare experiences
• Build and fine-tune models predicting individual member behaviors
• Develop scalable, automated pipelines for model outputs
• Collaborate with engineering teams to version, test, and deploy models using Git, CI/CD pipelines, and virtual machine environments
• Partner with Coding, Compliance, CDI, Clinical, and Legal teams to align data outputs with CMS guidance
• Standardize definitions, documentation logic, and reporting workflows to support enterprise-wide AI readiness
• Support the Stars team analytics backbone through data cleaning, aggregation, and dashboarding

Call Center Representative

• Lead, coach, and develop Pharmacy Technician Leads and Pharmacy Technicians
• Monitor team performance and provide feedback, mentoring, and career development
• Conduct performance evaluations and support performance management activities
• Translate strategic priorities into effective daily workflows
• Foster accountability, engagement, and continuous improvement
• Partner with pharmacy leadership to implement workflow enhancements and operational policies
• Ensure compliance with departmental procedures and regulatory requirements
• Support audit readiness and documentation quality standards
• Assist with claims processing issues, PBM interactions, and member/provider communications
• Collaborate across teams to improve pharmacy quality outcomes, Star performance, and member satisfaction
• Support pharmacy programs, campaigns, quality initiatives, and PBM oversight activities
• Recruit, hire, onboard, train, and develop team members
• Assign and monitor workloads
• Coach, counsel, and manage performance
• Build a high-performing, engaged technician team

Pharmacy Contact Center Manager

Implementation Specialist

• Lead implementation of new and revised regulatory requirements impacting Medicare Advantage operations
• Translate complex regulatory guidance into actionable implementation plans and operational requirements
• Coordinate enterprise-wide readiness efforts for regulatory and compliance initiatives
• Develop project plans, milestones, dependencies, and implementation timelines
• Assess operational impacts across enrollment, claims, grievances and appeals, member services, pharmacy, provider operations, care management, quality and Stars, sales and marketing, risk adjustment, and technology
• Coordinate cross-functional business, operational, and technology teams
• Facilitate implementation working groups and governance meetings
• Manage project risks, dependencies, issues, and escalations
• Develop and execute regulatory readiness plans
• Update policies, procedures, workflows, and job aids
• Coordinate business process redesign and operational changes
• Support training and communication initiatives
• Coordinate technology enhancements, system configurations, and vendor updates
• Oversee UAT, Business Validation Testing, Readiness Testing, and Production Validation
• Support corrective action plans resulting from CMS audits and compliance reviews
• Maintain implementation documentation and audit trails
• Coordinate regulatory implementation with third-party vendors and delegated entities
• Develop executive implementation status reports and dashboards
• Present progress, risks, and readiness assessments to leadership
• Provide go-live readiness and risk mitigation recommendations

Senior Regulatory Implementation Manager

• Partner with Pharmacy leadership to understand business problems, propose analytical solutions, and turn findings into actionable stakeholder takeaways
• Convert analytical models and business rules into scalable, production-ready tools
• Design dashboards and reporting tracking Stars measure trajectories and intervention impact
• Build cut-point projection and simulation models forecasting Star Rating outcomes under varying performance and CMS methodology scenarios
• Build prioritization rules, measure improvement models, and next-best-action logic
• Analyze the financial impact of pharmacy and Star performance to support investment and intervention decisions
• Manage projects end to end from problem definition through analysis, model building, validation, deployment support, and ongoing monitoring
• Collaborate with data and engineering teams to version, test, and deploy models using Git, CI/CD pipelines, and virtual machine environments
• Standardize definitions, documentation logic, and reporting workflows to scale enterprise-wide AI-readiness
• Introduce new data sources, techniques, and emerging tools to improve analytical capabilities
• Perform other duties as assigned by the manager

Data Scientist, Pharmacy – Part D Stars

Director

• 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

Senior Director, Care Delivery Org – Value Based Care Contracting

Growth Marketing

• Develop and execute annual and multi-year CDO membership growth plans for Nevada, Texas, Arizona, and North Carolina
• Drive AEP readiness and enrollment execution across all four markets
• Coordinate with Provider Contracting, CDO market leadership, and directly contracted physician groups on enrollment goals and activation strategies
• Analyze market-level enrollment trends, competitive positioning, physician practice dynamics, and membership expansion opportunities
• Develop and maintain growth analytics frameworks tracking enrollment, attribution, membership trends, campaign performance, and ROI
• Optimize resource allocation and report results to CDO leadership
• Develop and oversee the CDO growth budget
• Allocate resources across markets, physician group activation programs, and AEP campaigns
• Track spending against enrollment and membership outcomes and reallocate investment toward high-performing channels
• Build, lead, and develop the CDO Strategic Growth team
• Recruit, onboard, coach, and manage performance and retention of marketing and growth staff
• Plan, assign, and direct work; appraise performance; reward and discipline employees; address complaints and resolve problems
• Perform other duties and projects as assigned

Senior Director, CDO Strategic Growth

Recruitment

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 Talent Acquisition Operations Coordinator is responsible for providing quality customer service support to Alignment Healthcare’s Talent Acquisition team. The Talent Acquisition Operations Coordinator will directly support Recruiters and Hiring Managers to ensure both internal and external candidates are receiving best class candidate experience. This individual will also assist with background checks, onboarding paperwork, scheduling of interviews, and other related projects. Additionally, this individual will be supporting other areas within the HR team on special projects and assignments.

GENERAL DUTIES/RESPONSIBILITIES:
1.    Supports the Talent Acquisition team on coordinating and scheduling candidate interviews including phone interviews, in-person interviews and video conference interviews. 
2.    Drives the scheduling process to ensure interviews are scheduled in a timely manner.
3.    Helps deliver an excellent candidate experience by ensuring candidates receive detailed information on interview and/or travel plans in a timely manner.
4.    Supports recruiters on job postings, job events and marketing campaigns.
5.    Supports all activities on onboarding a new hire:
a.    Compiles new hire data and enter information into the HRIS system.
b.    Completes new hire checklists and creation of employee profiles.
c.    Order background check as necessary.
6.    Administrators and tracks non-direct labor staff: 
a.    Approves Service Desk Tickets.
b.    Collects required paperwork for onboarding.
c.    Enters new hire data information into the HRIS system.
7.    Process invoices as necessary.
8.    Other Human Capital special projects or responsibilities as assigned.
Job Requirements:
Experience:
• Required: Minimum 1 years of administrative assistant or coordinator experience is required. 1+ years of high-volume calendar management, booking travel, etc. 1 year Microsoft Office Products experience is highly required. (Word, Excel, PPT).
• Preferred: 1+ years of recruiting operations experience is highly preferred.
Education:
• Required: High School Diploma or GED.  Bachelor's degree or four years additional experience in lieu of education.
Training:
• Required: None
• Preferred: Workday Talent module
Specialized Skills:
• Required:

- Computer Skills: Advanced knowledge of Microsoft Outlook e-mail and calendar functionality required including creating and using templates, and using third-party tools to schedule meeting locations, conference calls and video conference calls.

- Intermediate knowledge of Microsoft Word and Excel required including Mail Merge, formatting spreadsheets, basic formulas.

- Ability to communicate positively, professionally and effectively with others; teach and collaborate with others.

- Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

- Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly.

- Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.

- Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Licensure:
• Required: None
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $0.00 - $0.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. 

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.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Talent Acquisition Operations Coordinator

• Lead end-to-end implementation of strategic technology solutions, vendor services, and enterprise initiatives
• Develop and manage implementation plans, project timelines, milestones, dependencies, and risk mitigation strategies
• Coordinate cross-functional teams and facilitate implementation governance meetings
• Provide status updates to executive leadership
• Manage onboarding and integration of new vendors supporting Medicare Advantage operations
• Coordinate contract implementation, operational readiness, testing, and deployment
• Oversee vendor performance during implementation and stabilization
• Escalate and resolve implementation issues, risks, and delivery barriers
• Partner with IT and architecture teams to define and execute technical integration requirements
• Oversee system testing, user acceptance testing, defect remediation, and production readiness
• Validate and document upstream and downstream system integrations
• Develop operational readiness plans, business processes, workflows, training, and communications
• Ensure policies, procedures, and job aids support new capabilities
• Conduct readiness assessments and go-live reviews
• Support stabilization and transition solutions into ongoing operations
• Ensure compliance with Medicare Advantage regulatory requirements
• Collaborate with Compliance, Legal, Privacy, and Information Security teams
• Verify controls, documentation, and operational processes before launch
• Support audit readiness and implementation documentation
• Manage stakeholder expectations and drive alignment across business, operational, technical, and vendor teams
• Track implementation metrics, post-launch outcomes, and benefits realization
• Improve implementation methodologies and governance processes
• Capture lessons learned and establish implementation best practices

Implementation Manager – Tech & Vendor Integrations

• Define and execute the strategy to improve member operations across acquisition, enrollment, onboarding, engagement, service, retention, and renewal
• Develop a multi-year roadmap aligning operational improvements, technology investments, and business priorities
• Identify opportunities to improve member experience, operational efficiency, retention, and growth
• Design and evolve member operations operating models, workflows, governance structures, service models, and accountability frameworks
• Lead assessment and improvement of member journeys across the lifecycle
• Lead cross-functional process redesign, automation, workflow optimization, and standardization initiatives
• Partner with Product and Technology teams to prioritize technology investments and translate business requirements into scalable solutions
• Lead implementation of automation, AI-enabled capabilities, digital engagement tools, workflow technologies, and self-service solutions
• Establish KPIs and success measures, monitor performance, and ensure measurable business value and return on investment
• Develop business cases supporting transformation priorities and investment decisions
• Serve as primary liaison across Operations, Clinical Services, Product, Technology, Marketing, Analytics, Quality, Compliance, Network, Finance, and market leadership
• Facilitate governance forums and executive steering committees
• Evaluate technologies, vendors, and operational capabilities; develop recommendations and lead implementation efforts
• Individual contributor role

Member Lifecycle Director – Transformation

• Lead the annual and multi-year enterprise capital planning process
• Develop and maintain capital allocation strategies, governance policies, approval thresholds, and decision-making frameworks
• Facilitate capital review committees, investment councils, and executive governance forums
• Maintain the enterprise capital portfolio and investment pipeline
• Recommend capital allocation priorities and develop scenario analyses
• Lead business case development and capital request evaluation
• Establish methodologies for ROI, NPV, IRR, payback period, benefit realization, and risk assessment
• Oversee the capital investment portfolio and monitor utilization, performance, risks, dependencies, and resource constraints
• Partner with FP&A, Accounting, Actuarial, Treasury, and Strategy teams on financial planning and analysis
• Develop capital forecasts and expenditure projections; monitor approved versus actual spend and variances
• Prepare Board-level and Executive Leadership reporting packages, dashboards, and KPI reporting
• Establish post-implementation reviews and monitor financial and operational benefit realization
• Conduct investment look-back analyses and develop corrective action plans
• Partner with executive leadership on investment opportunities, corporate strategy, growth planning, mergers, acquisitions, provider partnerships, and expansion investments
• Assess emerging healthcare technologies, digital capabilities, and operational innovations
• Build and lead a high-performing Capital Planning Office
• Manage capital planning analysts, portfolio managers, and financial consultants
• Develop enterprise investment planning capabilities and best practices
• Foster collaboration across functional business units and serve as a trusted advisor to executive leadership

Senior Director, Capital Planning

Procurement

• Establish and lead the enterprise vendor management function for the Medicare Advantage health plan
• Develop and execute vendor governance strategies, performance management frameworks, risk oversight programs, and partnership models
• Oversee strategic vendors and delegated entities supporting claims administration, pharmacy services, care management, utilization management, member services, risk adjustment, quality improvement, provider operations, and technology platforms
• Develop vendor management and strategic partnership strategy, governance frameworks, policies, standards, and oversight processes
• Build a high-performing vendor management organization and create vendor segmentation models
• Serve as relationship owner for critical vendors and strategic partners
• Develop vendor leadership relationships and lead strategic business reviews and governance meetings
• Establish KPIs, SLAs, and performance scorecards; monitor performance and drive corrective action
• Oversee delegated entity and FDR governance and ensure compliance with CMS Medicare Advantage and Part D regulations
• Partner with Compliance, Regulatory Affairs, Legal, and Internal Audit on regulatory adherence, audits, remediation, and corrective action plans
• Establish vendor risk management programs covering operational, financial, compliance, cybersecurity, privacy, and reputational risks
• Oversee vendor financial performance and contract governance, including negotiations, renewals, amendments, cost optimization, and budgets
• Support growth initiatives, market expansion, acquisitions, product launches, technology implementations, and transformation programs
• Influence enterprise decision-making and align business leaders on vendor priorities
• Develop executive dashboards and reporting; present vendor updates, risks, opportunities, and recommendations to senior leadership
• Lead executive governance forums and support Board-level reporting as needed

Vendor Management Director

• Define and execute a multi-year strategy to improve provider operations
• Establish and manage a portfolio of transformation initiatives across provider functions
• Identify opportunities to improve efficiency, scalability, compliance, accuracy, and provider experience
• Develop business cases, investment plans, and success measures
• Design and implement operating models across provider operations functions
• Develop workflows, governance structures, service models, and accountability frameworks
• Simplify processes, eliminate redundancies, and improve cross-functional coordination
• Lead process redesign initiatives across Claims, Credentialing, Provider Data Management, Prior Authorization, Contracting, Delegation Oversight, and Provider Services
• Apply process improvement methodologies, automation, and industry best practices
• Partner with Product, Technology, and Operations teams to define technology priorities and implement scalable solutions
• Lead implementation of automation, AI-enabled capabilities, digital intake solutions, provider portals, and workflow platforms
• Establish KPIs and performance measures, monitor results, and ensure measurable business value and return on investment
• Develop executive reporting and dashboards
• Serve as primary liaison across Provider Operations, Network Management, Clinical Operations, Technology, Analytics, Compliance, Finance, and market leadership
• Facilitate executive governance forums and steering committees
• Build stakeholder alignment and drive adoption of new processes, operating models, and technologies
• Operate as an individual contributor