Alignment Health

Data Engineer

• Lead end-to-end data requirements and stakeholder analysis
• Drive data quality improvement across claims, membership, member, and provider data
• Direct triage, analysis, and resolution of Data Ops issues affecting production environments and customer-facing outputs
• Serve as subject matter authority for EDI and healthcare data standards, including X12 834/837 transactions
• Evaluate internal and external data sources for quality, coverage, and suitability for analytical, operational, and regulatory use cases
• Apply knowledge of cloud data platforms, streaming architectures, automation, and data quality as a service
• Partner with data engineering to enable scalable, modern analytics infrastructure
• Build team capability through mentorship, coaching, and change leadership
• Interview, hire, train, assign, direct, and appraise employees; reward and discipline employees; address complaints and resolve problems

Director, Data Engineering

• Define and maintain data engineering patterns, pipeline standards, and architectural guardrails
• Lead design of scalable data processing frameworks and transformation models for claims, encounters, risk adjustment, and member data
• Maintain accountability for platform reliability and data quality outcomes
• Apply machine learning and automation techniques in production data engineering environments
• Implement and continuously improve high-performance cloud-based data pipelines for real-time and batch workflows
• Serve as the technical subject matter expert for data engineering
• Mentor engineers through architecture reviews, design sessions, and internal documentation
• Evaluate emerging data technologies and make build-versus-buy recommendations
• Contribute to the multi-year data platform engineering roadmap
• Apply Medicare Advantage, CMS, HIPAA, HEDIS, and risk adjustment expertise to deliver audit-ready, compliant healthcare data solutions
• Provide informal technical leadership and subject matter guidance to Data Engineers and Senior Data Engineers
• Perform essential physical functions including talking, hearing, standing, walking, sitting, handling objects or controls, reaching, and occasionally lifting up to 10 pounds

Principal Data Engineer

Nurse Practitioner

• Conduct in-home assessments 3.5 days per week, with some outpatient clinical work
• Perform remote work 1.5 days per week
• Provide patient education by matching desired care with best care given
• Identify diagnoses for care management and active medical management
• Partner with the Regional Medical Officer and other team members to develop appropriate care plans
• Coordinate care with PCPs, specialists, and ancillary providers
• Lead a broader clinical team that may include nurses, health coaches, social workers, and care coordinators
• Provide care and support to eligible Alignment Healthcare patients in their homes
• Help prevent unnecessary hospitalizations, health complications, and unmanaged disease progression

Field Nurse Practitioner / Physician Assistant

• Conduct in-home assessments 3.5 days a week, with some outpatient clinical work, on health plan members
• Perform remote clinical work 1.5 days a week
• Provide patient education by matching desired care with best care given
• Identify diagnoses for care management and active medical management
• Partner and communicate with the Regional Medical Officer and other team members to develop appropriate care plans
• Coordinate care with PCPs, specialists, ancillary providers, and other stakeholders
• Lead a broader clinical team, potentially including nurses, health coaches, social workers, and care coordinators
• Provide care and support to Alignment Healthcare patients in their homes through the Care Anywhere program
• Help prevent unnecessary hospitalizations, health complications, and unmanaged disease progression

Telesales

• Generate leads to meet and exceed individual sales production of new enrollments
• Help retain existing members within company health plan(s)
• Handle inbound telephone inquiries from prospective members, providers, and community partners regarding all lines of business
• Direct prospects to the field sales team when needed
• Conduct outbound calls for enrollment/disenrollment campaigns, community-event information requests, provider-office requests, after-hours messages, and website inquiries
• Submit daily activity production reports and/or monthly reports as required
• Ensure information and assistance comply with applicable federal/state laws, regulations, and Alignment Health Plan's Compliance Department standards
• Understand updates related to company, CMS, and marketing guidelines
• Participate in competitor SWOT analysis within respective markets/territories as required
• Support Sales and Marketing Department projects as directed
• Perform other assigned duties

Telesales Retention Representative

Implementation Specialist

• 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 and manage stakeholder expectations
• 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, UAT, defect remediation, and production readiness
• Validate and document upstream and downstream system integration
• Develop operational readiness plans, business processes, workflows, training, and communications
• Update policies, procedures, and job aids; conduct readiness assessments and go-live reviews
• Support stabilization and transition solutions into ongoing operations
• Ensure Medicare Advantage regulatory and compliance requirements are supported
• Collaborate with Compliance, Legal, Privacy, and Information Security teams
• Verify controls, documentation, and operational processes before launch
• Support audit readiness and implementation documentation
• Track implementation metrics, post-launch outcomes, and benefits realization
• Improve implementation methodologies and governance processes; capture lessons learned and establish best practices

Implementation Manager – Tech & Vendor Integrations

Risk

• Provide executive leadership for Alignment's enterprise Risk Adjustment performance strategy and operations
• Lead development and execution of prospective, concurrent, and retrospective Risk Adjustment strategies
• Drive provider and market execution and achieve annual RAF performance objectives
• Oversee provider engagement, coding operations, chart retrieval, submission, analytics, vendor management, and revenue realization
• Partner with Market Operations, Network Management, Clinical Operations, Finance, Compliance, and Data & Technology teams
• Lead the annual operating plan, including goals, measures, milestones, resources and market-level execution plans
• Establish and monitor performance guidelines for quality, productivity, service levels and financial outcomes
• Use analytics, reporting and strategic business analysis to identify opportunities, risks, root causes and interventions
• Partner with Finance and Actuarial teams on forecasting, revenue implications, bid development and long-range planning
• Establish strategic direction and performance expectations for Risk Adjustment vendors and external partners
• Serve as executive sponsor for provider coding performance and documentation improvement initiatives
• Develop scalable reporting, analytical and operational capabilities supporting visibility, audit readiness and reduced manual controls
• Partner with DTS and enterprise analytics teams on data strategy and reporting capabilities
• Define requirements for workflow modernization, automation, provider enablement and enterprise reporting
• Sponsor technology initiatives improving scalability, productivity, transparency and audit readiness
• Support RADV readiness, validation findings, reconciliation, diagnosis corrections and audit remediation
• Establish policies, procedures, standard work and governance routines for accurate and compliant execution
• Maintain knowledge of CMS requirements, model changes and regulatory guidance and translate changes into operational plans
• Communicate complex operational, technical and financial information as executive insights and business narratives
• Build, mentor and retain a high-performing multidisciplinary team
• Develop multi-year strategies, annual goals, KPIs and resource requirements
• Lead business cases for investments, operational initiatives and technology capabilities
• Oversee assigned leaders and staff, including workforce planning, recruiting, training, goal-setting, performance management and coaching
• Perform other duties as assigned

AVP, Medicare Risk Adjustment Performance

Medical Director

• Report to the Senior VP of Clinical Operations, with accountability to the Chief Financial Officer and Chief Medical Officer
• Work with UM licensed staff, Regional Medical Officers, and Extensivists to optimize use of institutional and outpatient services while ensuring quality of care
• Complete remote clinical reviews through the web-based Portal for medical necessity, treatment appropriateness, and compliance
• Conduct second-level reviews under Medicare/CMS NCD, LCD, and Milliman guidelines for inpatient, outpatient, skilled-facility level of care, and pharmacy services
• Provide level-of-care classifications and continued-stay reviews
• Liaise among medical staff, utilization review teams, and third-party payers
• Review claim denials, pending claims, appeals, and grievances
• Serve as a physician member of the utilization review team
• Monitor overutilization and underutilization
• Develop utilization management protocols, including auto-approvals and market-specific protocols, with the Interdisciplinary Team
• Develop training materials and assist with physicians' annual interrater reliability testing
• Serve as a subject matter expert to Regional Medical Officers and/or Extensivists during concurrent reviews
• Chair the Medical Quality Committee and provide clinical oversight of quality outcomes
• Collaborate with and assist the Quality Director
• Educate community physicians on utilization management processes and regulations with Provider Relations, Network Management, and Regional Medical Officers
• Challenge physician practices to achieve organizational clinical outcomes
• Provide oversight of UM clinical staff

Medical Director – Utilization Management

Actuary

• Develop, maintain, and audit actuarial models and traditional actuarial methods supporting monthly reserve balances, RAF accruals, Part D pass-through accruals, forecasting, trend analysis, and financial projections
• Analyze healthcare cost and utilization trends, including pharmacy, medical cost drivers, claim adjudication, and utilization management KPIs
• Support pricing, reserving, and financial planning activities, including budget and forecast cycles
• Recommend methodology changes based on changing circumstances and operational deviations
• Collaborate with HealthPlan Economics, Medicare Risk Adjustment, finance, pharmacy, clinical, operations, and external stakeholders
• Review financial performance across markets and translate complex analytics into clear business insights
• Conduct data-driven analyses for strategic decision-making, program performance evaluation, and risk and opportunity assessment
• Explain actuarial methods and analyses to non-actuarial stakeholders and leadership through reports, dashboards, and presentations
• Ensure data integrity, validation, and reconciliation across multiple data sources for regulatory and financial reporting
• Perform other duties as assigned

Senior Actuarial Analyst

• Build and lead the organization’s program evaluation and causal analytics capability
• Own end-to-end evaluation strategy for priority clinical, operational, and benefit interventions
• Select study designs, define cohorts and outcomes, establish measurement windows, and develop analytic plans
• Design and execute causal inference evaluations using propensity score methods and difference-in-differences
• Establish and maintain an evaluation playbook with standardized templates, attribution rules, risk adjustment, and reporting conventions
• Quantify intervention impact across cost, utilization, quality, savings, ROI, and operational KPIs
• Partner with clinical and operational leaders to establish measurement standards and assess evaluation feasibility
• Support cross-functional governance of metric definitions and analytic standards
• Translate causal and statistical findings into executive narratives and recommended actions
• Work with medical/pharmacy claims, enrollment, provider, and operational data to validate assumptions and ensure analytic integrity
• Promote data quality, reproducibility, transparent code, documentation, and version control
• Develop reusable code modules, cohort builders, standardized outcome tables, dashboards, and evaluation pipelines
• Provide methodological guidance on power, confounding, selection bias, regression-to-mean, contamination, risk adjustment, and segmentation
• Apply or oversee advanced economic and statistical analyses when appropriate
• Recruit, select, orient, train, assign, monitor, appraise, coach, counsel, and discipline assigned staff

Sr. Director, Healthcare Analytics

General

• Work alongside the Manager of Product on product management activities
• Navigate product management processes and coordinate traffic flow, emphasizing Medicare lines of business
• Research Medicare HMO and PPO regulations, competitors, products, markets, and trends
• Conduct product research for filings, bids, and selling periods
• Assist with health plan Service Area Expansion filings through state and federal agencies
• Collect data elements for Service Area Expansion and Annual Bids
• Maintain knowledge of competitor products and identify market opportunities
• Ensure accuracy of member-facing media for specific Medicare Advantage plans
• Maintain knowledge of government programs, health insurance markets, healthcare reform, and product trends
• Collaborate with Compliance, Pharmacy, Finance, Healthcare Services, Quality, Marketing, Enrollment, and Sales departments

Product Coordinator

• Lead federal, state, and local tax compliance, including income, franchise, and insurance premium tax filings
• Manage tax calendars, estimated payments, extensions, and filing deadlines
• Coordinate with external tax advisors and auditors
• Prepare quarterly and annual ASC 740 income tax provisions
• Maintain tax workpapers, deferred tax calculations, effective tax rate analyses, and financial statement disclosures
• Support internal and external audit requests
• Handle tax notices, audits, and inquiries from federal and state authorities
• Collaborate with Accounting, FP&A, Legal, and Operations on tax implications and business initiatives
• Assist with regulatory, financial audit, and Medicare Advantage-related data requests
• Monitor tax legislation, regulatory developments, and IRS guidance
• Translate complex tax issues into recommendations for Finance leadership
• Improve tax processes, automation, compliance workflows, and SOX controls
• Use OneSource, CorpTax, Oracle, and Workday
• Complete additional duties and special projects as assigned

Senior Tax Analyst

• Lead end-to-end preparation and review of federal, state, and local tax filings, including income, franchise, and insurance premium tax returns
• Manage the tax compliance calendar, estimated payments, extension filings, and statutory obligations
• Support external tax advisors and auditors with documentation and analysis
• Prepare and review quarterly and annual ASC 740 income tax provisions
• Calculate deferred tax assets and liabilities, analyze effective tax rates, and prepare financial statement disclosures
• Maintain audit-ready tax provision workpapers and supporting documentation
• Lead responses to tax notices, audits, and inquiries from federal and state tax authorities
• Track correspondence and audit activity through resolution
• Partner with Accounting, FP&A, Legal, and Operations on tax implications and business decisions
• Support data requests related to Medicare Advantage operations, regulatory filings, enrollment reconciliations, and financial audits
• Research tax legislation, IRS guidance, and state law changes and translate findings into actionable summaries
• Coordinate with external tax advisors on technical positions, ruling requests, and complex issues
• Improve tax compliance workflows, including automation within OneSource, CorpTax, Oracle, and Workday
• Maintain organized records and support SOX internal control compliance

Bilingual

• Manage and coordinate health care for members with complex and chronic care needs within the scope of licensure
• Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
• Coordinate and monitor member progress and services to ensure consistent, cost-effective care compliant with policies and regulations
• Create individualized discharge plans with patients, families, and the care team
• Coordinate care with providers, rehabilitation facilities, and home health agencies
• Monitor patient progress and adjust care plans as needed
• Educate and empower patients and families for self-care and follow-up
• Advocate for patient needs and connect them to community support services
• Participate in care conferences, quality improvement initiatives, and interdisciplinary collaboration
• Perform duties mostly telephonically

RN Case Manager – Care Transitions, Bilingual Spanish

• Reach out to members by telephone to assist with referrals, authorizations, home health care, durable medical equipment needs, medication refills, provider appointments, and follow-ups
• Create cases and tasks and complete documentation in the Case Management module for hospital and skilled nursing facility discharges
• Complete and document tasks assigned by the nurse
• Collaborate with the Case Manager to engage and manage a panel of members
• Manage new alerts and update the Case Manager about changes in condition, admissions, discharges, or new diagnoses
• Establish relationships with members, earn their trust, and act as a patient advocate
• Escalate concerns to the nurse when members appear non-compliant or show a change in condition
• Assist with outreach activities for members across Case Management Programs
• Maintain and update member records
• Mail or fax correspondence to members, primary care physicians, and specialists
• Request and upload medical records from primary care physicians, specialists, hospitals, and other sources
• Meet deadlines and prioritize tasks according to department policies, standards, and needs
• Maintain confidentiality of information among healthcare professionals
• Perform other duties assigned by the Care Management Supervisor, Manager, or Director

Director, Data Engineering

Principal Data Engineer

Field Nurse Practitioner / Physician Assistant

Field Nurse Practitioner / Physician Assistant

Telesales Retention Representative

Implementation Manager – Tech & Vendor Integrations

AVP, Medicare Risk Adjustment Performance

Medical Director – Utilization Management

Senior Actuarial Analyst

Sr. Director, Healthcare Analytics

Product Coordinator

Senior Tax Analyst

Senior Tax Analyst

RN Case Manager – Care Transitions, Bilingual Spanish

Care Coordinator, Transition of Care, Bilingual Spanish