Alignment Health

Care Coordinator

• Responsible for day-to-day support of the patients and providers in the Virtual Care Center
• Answering calls in the phone queue
• Scheduling telephonic and virtual appointments
• Following up on referrals and authorizations
• Supporting outbound follow-up calls
• Providing systems trainings for new hires
• Completing administrative tasks as applicable
• Managing inbound and outbound calls in the phone queue
• Collaborating with a cross-functional team of Clinical Operations, Member Services, AVA Product team, and DTS Help Desk support
• Assisting Alignment staff and patients with resolution of issues in a timely manner

Telehealth Coordinator – Saturdays Required

Physician Advisor

• Processes second level reviews in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy.
• Provides appropriate level of care classifications as well as continued stay reviews in compliance with CMS and Milliman guidelines.
• Acts as a liaison between the medical staff, utilization review and 3rd party payers to effectively promote the appropriate levels of medical care.
• Reviews the entire claim denial process, including Appeals and Grievances.
• Serves as a Physician member of the utilization review team.
• Works with Interdisciplinary Team to develop case management protocols and provide oversight for NP’s/PA’s training.
• Acts as a Clinical Leader for HEDIS and STARS projects and serves as Clinical Advisor for HCC and RAF.
• Serves as a Chairperson for Medical Quality Committee and provide Clinical Oversight for Chronic Disease Management programs and Quality Outcome.
• Collaborates closely and provide assistance to Quality Director.
• Works with Extensivists and Middle Level Practitioners (NP’s/PA’s) to reduce length of institutional stay, all cause readmission reduction and ER overutilization ensuring patients and therapeutic modalities.
• Assists the organization to challenge physician practices in order to achieve the organization's clinical outcomes and quality goals.

Physician Advisor – Part Time, 1099, CA License Required

General

• Developing and maintaining strong relationships with provider offices to improve network performance, enhance provider satisfaction, and support organizational growth.
• Partnering with providers on strategies to increase patient retention and growth.
• Driving performance across key quality and utilization metrics.
• Serving as the main point of contact for providers, offering education, support, and tools to achieve goals.
• Conducting initial provider onboarding and provides support for ongoing provider education on Alignment tools, clinical programs, and other compliance requirements.
• Facilitating and serving as a single point of resolution for provider issues.
• Documenting meeting minutes and action items as needed.
• Maintaining weekly summary of activity and submitting reports on a weekly basis.
• Attending and participating in all staff meetings as required.

Field Provider Engagement Specialist

• Assess patient concerns and provide telephonic and video-based clinical support
• Collaborate with primary care providers to develop care plans
• Conduct outbound calls and virtual visits for patient follow up
• Educate members on symptoms and care processes
• Utilize multiple technology platforms and complete documentation in EMR

RN Nurse Health Specialist, California RN License Required

• Assure that services are provided at the most appropriate, cost effective level of care needed to meet the patient’s medical needs while maintaining safety and quality.
• Performs reviews of inpatients with complex medical and social problems.
• Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician.
• Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting.
• Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities.
• Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary.
• Communicates and collaborates with IPA/MG as necessary for effective management of Members.
• Assigns and provides daily oversight of the activities and tasks of the CCIP Coordinator.
• Records communications in EZ-Cap and/or case management database.
• Arranges and participates in multi-disciplinary patient care conferences or rounds.
• Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure.
• Monitors for any over utilization or underutilization activities.
• Generates referrals as appropriate to the QM department.
• Enters data as necessary for the generation of reports related to case management.
• Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management.
• Performs other duties as assigned.

Inpatient Review Nurse, California RN/LVN License Required

• Develop and maintain strong relationships with provider offices to improve network performance.
• Enhance provider satisfaction and support organizational growth.
• Partner with providers on strategies to increase patient retention and growth.
• Drive performance across key quality and utilization metrics.
• Serve as the main point of contact for providers, offering education, support, and tools to achieve goals.
• Build and maintain collaborative relationships with providers and their staff to support growth.
• Conduct initial provider onboarding and provide support for ongoing provider education.
• Assist in the development of training and educational materials/tools.
• Facilitate and serve as a single point of resolution for provider issues.
• Document meeting minutes and action items as needed.
• Maintain weekly summary of activity and submit reports on a weekly basis.

Provider Engagement Specialist

Analyst

• Execute Accurate HCC Coding from Member Medical Records.
• Review prospective and retrospective member medical records and assign accurate, compliant HCC codes using ICD-10-CM coding guidelines to support CMS Risk Adjustment submissions.
• Conduct Structured Provider Coding Audits.
• Perform structured audits of provider documentation and coding practices for assigned physician groups and clinical staff — identifying patterns of under-documentation, missed conditions, and coding inaccuracies, and delivering specific, actionable feedback that drives measurable and sustained improvement.
• Deliver Provider-Facing Education and Training.
• Develop and deliver targeted education on coding standards, CMS Risk Adjustment requirements, and clinical documentation best practices — tailoring content to the needs of PCPs, specialists, and clinical support staff across assigned CDO provider groups.
• Identify and Close Provider-Level Documentation Gaps.
• Flag unsupported diagnoses, incomplete clinical documentation, and missing eligible conditions — communicating findings directly to providers and care teams to close risk capture gaps at the source and reinforce documentation standards.
• Ensure Compliance with CMS Coding Guidelines.
• Apply current CMS Risk Adjustment coding rules, Official Guidelines for Coding and Reporting, and organizational policies to all coding and provider education activities — minimizing audit risk and ensuring submission integrity.
• Meet Productivity and Quality Standards.
• Achieve daily coding productivity targets and maintain quality scores at or above established benchmarks, contributing directly to the CDO's RAF accuracy and performance goals.
• Maintain Current Knowledge of Coding and Regulatory Updates.
• Stay current on ICD-10-CM updates, CMS Risk Adjustment model changes, and HCC coding guidance — applying changes promptly to all coding work and updating provider education materials accordingly.
• Support Data Integrity and Accurate Reporting.
• Ensure all coded data is entered accurately into applicable systems to support downstream risk adjustment reporting, encounter data submissions, and performance analytics used by CDO leadership

Coding Analyst

• Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.
• Partner with providers to improve performance on key performance indicators (KPIs), including but not limited to growth, retention, Annual Wellness Visits (AWVs), HEDIS gap closures, hospital and ER utilization, risk adjustment and other quality indicators.
• Conduct initial provider onboarding and provide support for ongoing provider education on Alignment tools, clinical programs, PCP incentives, Member benefit offerings, Model of Care and other compliance requirements, and Alignment initiatives.
• Assist in the development of training and educational materials/tools.
• Create provider in-service and implementation packets.
• Facilitate and serve as a single point of resolution for provider issues, including but not limited to UM, prior authorization, claims, encounter data, eligibility, provider rosters and directory validation.
• Represent Alignment Health at provider meetings, trainings, and community events.
• Document meeting minutes and action items as needed.
• Consistently utilize, update and maintain department databases and tracking tools to ensure provider engagement activities, provider visits and outcomes are documented and monitored.
• Negotiate and implement standard physician and ancillary agreements; obtain provider credentialing; utilize network database to track recruitment activity.
• Maintain weekly summary of activity and submit reports on a weekly basis.
• Attend and participate in all staff meetings as required.
• Perform special projects as assigned.

Provider Engagement Specialist – Field

• Assist team with daily census by entering face sheets for hospitals and skilled nursing facilities (SNF).
• Obtain medical records from hospitals and SNF’s.
• Attach medical records to authorizations.
• Enter referral requests / authorizations in system using ICD 10 and CPT coding.
• Monitor fax folders.
• Complete and document tasks as assigned by nurse.
• Maintain documentation on facilities contacted.
• Assist with maintaining and updating member’s records.
• Assist with mailing or faxing correspondence to facilities, related to, as needed.
• Request medical records from facilities, etc., related to members activities, as needed.
• Attend case management presentations and participates, as appropriate.
• Recognize work-related problems and contributes to solutions.
• Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs.
• Maintain confidentiality of information between and among health care professionals.
• Be a positive team player.

UM Coordinator – Inpatient

• Performs reviews of inpatients with complex medical and social problems
• Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician
• Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting
• Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on acceptable evidence-based guidelines used by AHC
• Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities

Inpatient Review Nurse, California RN/LVN License Required, Part-Time, Weekends, Pacific Time Schedule

Bilingual

• Responsible for health care management and coordination within the scope of licensure
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
• Coordinates and monitors member’s progress and services
• Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists

Bilingual Spanish RN Case Manager – Transitions of Care

Technical Product Manager

• Own end-to-end product strategy for UM and key AVA platform domains
• Partner with Operations, Transformation, and Clinical teams to redesign workflows that improve clinical outcomes
• Drive AI-enabled automation opportunities across intake, clinical review, authorization decision support, workflow routing, and operational reporting
• Drive AVA platform evolution and ensure strategic alignment across key business domains
• Mentor product managers and demonstrate best practices, elevating product thinking, execution quality, and cross-team collaboration
• Conduct product portfolio opportunity assessments, identifying product gaps and new opportunities to grow market share and enhance experience

Senior Technical Product Manager

Vice President

• Develop and execute multi-year Risk Adjustment business plan
• Establish, track, and drive performance targets and KPIs across all Risk Adjustment programs
• Lead provider engagement strategies to improve HCC coding accuracy
• Direct and develop a high performing Risk Adjustment team
• Maintain expert regulatory and competitive intelligence in CMS regulations

VP, Physician Documentation, Value Performance

Customer Support

• Provides in-market, specialized member support
• Conducts in-market member engagement
• Ensures members have access to PCP and specialists
• Educates members on gaps in care

Customer Service Representative, Bilingual in Spanish

Manager

• Lead, mentor, and develop a team of RN Case Managers, ensuring alignment with organizational policies and regulatory standards
• Oversee daily outpatient case management operations, including referrals, transitions of care, and care coordination
• Maintain audit readiness by coordinating chart reviews and monitoring case management processes
• Train and onboard new staff while providing ongoing coaching and performance feedback
• Assign and prioritize team workload to ensure efficiency and quality outcomes
• Collaborate cross-functionally with Medical Directors, Quality, and Compliance leadership
• Manage escalated cases and step in to perform case management duties as needed
• Ensure accurate and compliant documentation across all team activities
• Analyze and report clinical and program data to leadership to support continuous improvement
• Support the development and implementation of protocols, workflows, and best practices
• Supervise a team of RN Case Managers and coordinators
• Lead hiring, onboarding, and training efforts
• Provide performance management, coaching, and development