Alignment Health

Marketing

• Provide enterprise level leadership over marketing strategy
• Set multi year strategic direction and drive brand growth
• Oversee integrated marketing efforts across digital, print, and events
• Lead a team of Directors and Senior Managers
• Manage substantial budgets and serve as strategic partner to senior leadership

AVP, Marketing – Planning

Customer Support

• Deliver compassionate and seamless service to valued members
• Build caring connections and advocate for the member
• Resolve member inquiries and take personal responsibility for interactions
• Document all member interactions and actions taken
• Address member complaints and complaints effectively
• Participate actively in ongoing coaching and learning

Spanish Bilingual Customer Experience Specialist

Project Manager

• Design, implement, and govern a standardized, scalable project management methodology
• Act as the lead subject matter expert in process improvement
• Develop, implement, maintain and report on the capacity of the IT organization to intake work
• Lead the change management initiatives required to ensure successful adoption of new project management methodologies
• Lead multiple complex, enterprise-wide initiatives
• Serve as a senior-level mentor and coach to project managers and operational teams
• Define and track key performance indicators (KPIs)
• Evaluate, select, and optimize project management and business process management (BPM) software and tools
• Partner with senior leaders and stakeholders to align project and process optimization initiatives with strategic goals
• Proactively identify and address risks related to project execution and process failures
• Foster a culture of continuous improvement

Principal Project Manager

Business Analyst

• Act as a liaison between business units and IT teams
• Collect and document business and technical requirements for IT projects and enhancements
• Analyze workflows and identify opportunities for optimization
• Create reports and dashboards to track key performance indicators
• Ensure adherence to organizational standards and regulatory requirements

Production Operations & Support Business Analyst

Technical Product Manager

• Own end-to-end product strategy for key AVA platform domains
• Drive product strategy and translate business needs into optimized technical solutions
• Champion AI-enabled automation and intelligence
• Partner with business and optimization teams to identify high-impact capabilities
• Mentor product managers and demonstrate best practices
• Drive strategy and roadmap for next-generation operations, clinical, and care coordination apps

Senior Technical Product Manager

Bilingual

• Conducts telephonic outreach to assigned members to assess health, environment, nutrition, and psycho-social areas of concerns using a variety of assessments.
• In response to assessments, coaches and problem solves with member to identify and address specific goal(s) to support health and behavior change.
• Provides appropriate interventions to optimize health and well-being. Interventions may include education, the coordination of community-based support services, and other resources.
• Charts member's treatments and progress in accordance with state regulations and department procedures.
• Makes referrals to case manager, as appropriate, and/or refers member's family to community support services and resources.
• Provides home assessment to high-risk members and develop an individual care plan.
• Collaborates with physicians in screening and evaluating members for psychotropic medications.
• Understands the clinical program design, program monitoring and reporting.
• Practices as an interdependent member of the health team and provides important components of primary health care through direct social work services, consultation, collaboration, referral, teaching, and advocacy.
• Assess and treats outpatients in individual and family modalities exercising mature professional judgment and using a wide range of social work skills to include individual and family counseling to assist patients and their families in dealing with chronic and acute diseases/injuries.
• Conducts psychosocial assessments to determine patient needs and resources (both family support and community support).
• Provides counseling to patient and family in matters directly related to patients’ limitation, adjustment to medical condition, and ongoing treatment.
• Develops and implements discharge plans, follow-up care, and transfers to other health care facilities (e.g., nursing homes, rehabilitation hospitals, etc.).
• Provides consultation services to medical, nursing, and ancillary hospital staff regarding psychosocial issues, discharge plans, and follow-up care for patients and families.
• Provides crisis intervention services.
• Responds independently, and with various media, to appropriate community requests. Takes the initiative in seeking out opportunities to present programs to meet the needs of patients/members and their families.
• Consults with Hospital administration, and Plan supplying information and feedback regarding procedures and services provided by the Psychology Division.
• Develops and maintains working relationships with community resources. Coordinates with physicians, and representatives of their service disciplines for the benefit of the member and their families. Takes initiative in identifying and assessing the needs of the community and organizes responses to address those needs.
• Interfaces with the RN Case Manager(s) and the Interdisciplinary Team (IDT) in the development and implementation of the Case Management Program (CMP).
• Integrates social work case management and nurse case management as a team.

Bilingual Spanish Social Worker, LMSW/LCSW

Cloud Engineer

• Work directly with product management and your team
• Collaborate with your team to manage and estimate the size of features
• Own system and feature quality throughout all phases
• Drive value and build to continuously improve the quality of the team’s deliverables
• Contribute to software engineering best practices

Senior Kubernetes Cloud Engineer

• Manage (4) provider schedules ensuring that schedules are filled.
• Prepare charts for upcoming home visit appointments.
• Conduct outreach for scheduling, appointment confirmation calls.
• Daily inbound / outbound call quota of minimum 60 - 80 calls / day.
• Obtain medical records from provider offices, hospitals, and upload medical records to electronic medical records (EMR).
• Submit referral authorizations to independent physician associations (IPA) / medical groups.
• Coordinates lab orders and transportation for high-risk members.
• Documentation via EMR for inbound / outbound calls.
• Assist nurse practitioner (NP) team with visit preparation needs.
• Direct inbound calls from members / family related to medication refills.

Care Coordinator, Bilingual Spanish, Medical Assistant

Clinical Operations

• Lead End-to-End Implementation of Condition Management Programs
• Own the planning, execution, and ongoing management of condition management programs
• Lead multiple parallel workstreams across multiple vendors
• Manage Vendor Performance, Outcomes, and ROI
• Establish governance structures, performance metrics, and reporting cadences
• Partner with Analytics and Finance to validate savings
• Drive Cross-Functional Coordination and Continuous Improvement

Senior Clinical Program Manager

Manager

• Manages the day-to-day operations ensuring timely and accurate resolution of provider disputes.
• Develops and implements department metrics and performance standards; assists team in meeting or exceeding departmental performance standards.
• Maintains compliance in all areas of operations.
• Monitors staff production and work quality.
• Ensure staff fully understands expectations.
• Conducts quality audits and root-cause analyses to identify opportunities for improvement and implement corrective actions.
• Collaborate effectively with cross-functional teams and develop positive relationships with internal and external stakeholders to ensure timely and accurate resolution of payment disputes.
• Serves as the subject matter expert to assist with regulatory audits, as required, as well as prepare materials required for regulatory audit submission.
• Analyze dispute trends and root causes to identify operational gaps and recommend process improvements.
• Provides guidance and support to team members in resolving complex claim disputes.
• Develops and maintains department’s policies, procedures and workflows which support efficient and compliant provider dispute resolutions.
• Manage and oversee vendor performance, ensure contractual compliance and service level agreement.
• Lead and motivate a high-performance team through effective recruitment, onboarding, training, and retention strategies.

Senior Manager, Provider Disputes Resolution

Director

• Create and implement a multi-year pharmacy Stars and quality roadmap
• Monitor CMS methodology updates and assess their impact on pharmacy measures
• Anticipate emerging trends and proactively adjust strategies
• Lead the development and execution of pharmacy-driven strategies to improve Stars measures and quality outcomes
• Monitor current performance and evaluate interventions with added focus on areas of opportunity or risk
• Lead internal pharmacy programs and PBM/vendor partnerships
• Represent Pharmacy in PBM, vendor, and cross-functional forums
• Build and deliver dashboards, forecasts, and executive reports
• Lead, mentor, and develop a high-performing team

Director, Pharmacy Quality – Part D Stars

Business Intelligence Developer

• Translate business requirements into specifications for reports and dashboards
• Work with business units to gather requirements and lead end to end BI delivery
• Develop and implement business intelligence & analytics to support organizational initiatives
• Build rich and dynamic dashboards using out-of-box features and customizations
• Design and publish custom dashboards for stakeholders and corporate users
• Design, model, develop & optimize stored procedures for data management and reporting
• Troubleshoot and resolve issues with the BI platform
• Provide input into the technical architecture and data warehouse technology stack

Senior BI Engineer

• Manage, train, and mentor a team of UM/Case Managers; enforce performance standards; handle denials and appeals
• Conduct/oversee concurrent review of inpatient stays for medical necessity, appropriateness, and length of stay, using tools like Milliman (MCG) or Medicare manuals
• Act as a liaison between patients, families, providers, and facilities; ensure smooth care transitions and discharge planning
• Ensure documentation meets regulatory and payer requirements; maintain accurate patient records
• Identify opportunities to improve cost-effectiveness while maintaining quality of care
• Prepare reports on quality, utilization, and cost savings for leadership
• Oversee assigned staff; responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees

Senior Manager, Inpatient Utilization Management – LVN/RN Required

• Leading the strategic development and operational execution of Virtual Care Center
• Ensuring delivery of high-quality patient-centered virtual care services
• Collaborating with cross-functional teams to optimize workflows
• Managing budget planning and resource allocation

Director, Virtual Health

• Responsible for capacity planning across the enterprise in support of member, provider, high touch, cases, claims, reimbursement, and email interactions
• Creates reporting to support needs
• Monitors and analyzes contact center performance on a historical and real-time basis
• Performs reviews of upcoming staffing on short-term horizon
• Responsible for work force planning capacity planning/forecasting, scheduling, real-time, reporting and systems
• Communicates with operations and leadership regarding significant factors impacting performance
• Participates in routine leadership meetings to review service results
• Ensures reporting is accurate and completed in a timely manner
• Plans, schedules and adjusts workforce to ensure optimal utilization of contact center resources
• Acts as a key leader for Customer Experience during technical incidents or system outages