Alignment Health

Risk

• Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records
• Develops education materials to assist physicians in accurately assessing patients’ overall health status
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes
• Maintains a comprehensive tracking and management tool for assigned physicians within Alignments Healthcare provider network
• Identifies issues, determines impact to risk adjustment models, and reports results timely to ensure that physicians remain in compliance
• Collect, analyze, and share MRA performance data through clear presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for use through Joint Working Groups (JWGs) with internal and external stakeholders
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures
• Presents progress and results to leadership on a routine basis
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes
• Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation
• Suggests customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
• Stays current on industry coding, compliance and HCC issues
• Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies

Risk Adjustment Provider Engagement Lead

Bilingual

• Create individualized discharge plans with patients, families, and the care team
• Coordinate care with providers, rehab facilities, and home health agencies
• Monitor patient progress and adjust 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

Bilingual Spanish Nurse Case Manager – Care Transitions, RN, CA License

Sales

• Generate leads to meet and exceed individual sales production of new enrollments
• Handle inside/in-bound telephone inquiries
• Conduct outbound calls relevant to enrollment/disenrollment
• Submit daily activity production reports

TeleSales Retention Representative, CA Licensed

• Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records
• Develops education materials to assist physicians in accurately assessing patients’ overall health status
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes
• Maintains a comprehensive tracking and management tool for assigned physicians within Alignments Healthcare provider network
• Identifies issues, determines impact to risk adjustment models, and reports results timely to ensure that physicians remain in compliance
• Collect, analyze, and share MRA performance data through clear presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for use through Joint Working Groups (JWGs) with internal and external stakeholders
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures
• Presents progress and results to leadership on a routine basis
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes
• Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation
• Suggests customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
• Stays current on industry coding, compliance and HCC issues

Consultant

• Design, implement, and maintain compensation programs
• Analyze internal and external compensation data
• Administer equity and executive compensation programs
• Support annual compensation planning processes

Corporate Compensation Consultant

Recruitment

• Support recruiters with resume review, candidate screening, and job posting coordination.
• Manage end-to-end interview scheduling (phone/video/onsite), including confirmations, changes, and logistics.
• Communicate with candidates throughout the process to ensure a timely, positive candidate experience.
• Partner with hiring managers and interview teams to align schedules, share interview plans, and keep the process moving.
• Maintain accurate ATS records and prepare basic recruiting status updates/metrics.
• Support recruiting events and ensure confidentiality and compliance with policies and employment laws.
• Other duties as assigned.

Recruiting Coordinator – Temporary

Medical Director

• Reports to the Senior VP of Clinical Operations with accountably to Chief Financial Officer and Chief Medical Officer.
• Work with UM licensed staff, Regional Medical Officers and Extensivists to develop and implement methods to optimize use of Institutional and Outpatient services for all patients.
• Complete clinical reviews for medical necessity, treatment appropriateness and compliance.
• Second level reviews in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy.
• Provide appropriate level of care classifications as well as continued stay reviews in compliance with CMS and Milliman guidelines.
• Act as a liaison between the medical staff, utilization review and third-party payers to effectively promote the appropriate levels of medical care.

Medical Director, Utilization Management

Director

• Own and evolve the enterprise delegated oversight strategy, ensuring alignment with corporate objectives, regulatory requirements, and value-based care priorities.
• Establish a holistic performance framework that integrates clinical, operational, financial, and compliance metrics across all delegated entities.
• Maintain accountability for delegated performance outcomes, including quality, utilization, risk adjustment, member experience, and cost of care.
• Ensure oversight models are scalable and adaptable to support organizational growth and increasing complexity in risk-bearing arrangements.
• Define and lead enterprise governance structures that proactively identify, assess, and mitigate risks across the delegated network.
• Oversee risk stratification methodologies, performance scoring, and audit frameworks to ensure consistency, rigor, and regulatory alignment.
• Act as the senior escalation point for performance and compliance risks, ensuring timely intervention and resolution of issues with enterprise impact.
• Provide regular, transparent reporting to executive leadership on delegated performance, risks, and mitigation strategies.
• Serve as the lead relationship owner for delegated partner executives, driving alignment on performance expectations and long-term strategy.
• Facilitate executive-level performance reviews with IPAs and MSOs, ensuring accountability and measurable improvement.
• Influence internal executive stakeholders by translating performance insights into strategic recommendations and action plans.
• Represent delegated oversight in enterprise initiatives, regulatory readiness efforts, and cross-functional planning.
• Drive the evolution of delegated oversight into a proactive, insight-driven function, leveraging analytics to identify opportunities and intervene early.
• Lead cross-functional collaboration with Clinical, Quality, Compliance, Network, and Operations teams to improve delegated outcomes.
• Promote standardization, best practice sharing, and continuous improvement across the delegated network.
• Ensure tools, reporting, and processes enable effective performance management and decision-making.
• Lead and develop a high-performing team, setting clear expectations and fostering a culture of accountability and continuous improvement.

Senior Director, Delegate Oversight

• Reports to the Senior VP of Clinical Operations with accountability to Chief Financial Officer and Chief Medical Officer.
• Works with UM licensed staff, Regional Medical Officers and Extensivists to develop methods to optimize use of Institutional and Outpatient services for all patients while ensuring quality of care.
• Completes clinical reviews for medical necessity, treatment appropriateness, and compliance through remote access to web-based Portal.
• Second level reviews in compliance with Medicare/CMS guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy.
• Provides appropriate level of care classifications and continued stay reviews.
• Act as a liaison between medical staff, utilization review, and third-party payers.
• Reviews the entire claim denial process, including pending claims, Appeals, and Grievances.
• Serves as a Physician member of the utilization review team.

Medical Director – Utilization Management

Data Scientist

• Architect end-to-end AI/ML solutions for complex healthcare challenges
• Design and deliver production-grade machine learning systems for high-stakes applications including risk stratification, clinical decision support, autonomous chart review, and fraud detection
• Build reliable, scalable AI services including experimentation, validation, deployment, monitoring, drift detection, and continuous improvement
• Collaborate with Product, Clinical, Operations, and Compliance teams to identify high-value AI opportunities aligned with business strategy
• Mentor data scientists through code reviews and architectural discussions

Senior AI & Data Scientist

QA Engineer

• Monitors timeliness with Appeals and Grievances data
• Reviews case work end-to-end, ensuring workflow procedures are met to achieve Star Measure goals
• Analyzes and validates accuracy of Appeals and Grievance data according to plan business and CMS regulatory technical reporting requirements
• Validates and assists with enforcing that all complaint types are processed according to plan procedure and in compliance with the CMS guidelines
• Produces departmental quality performance reports for management review
• Manipulates and analyzes data from multiple report sources for quality review
• Assists with the preparation of audit universes and case samples
• Identifies training opportunities and potential system and process improvements relating to appeals and grievance data
• Assists with training and systems applications User Agreement Testing (UAT)
• Participates in departmental and regulatory compliance audits
• Maintains confidentiality and Health Insurance Portability and Accountability Act (HIPAA) compliance to ensure Protection of Health Information (PHI)

Quality Assurance Specialist – Appeal & Grievance

• Execute a talent acquisition strategy that supports business growth, transformation and workforce planning.
• Lead the enterprise Talent Acquisition function by successfully staffing the organization with high-quality talent in a timely, efficient, and cost-effective manner to support business growth and strategic initiatives.
• Create a compelling and authentic employer value proposition (EVP) that differentiates the organization in competitive markets.
• Accountable for talent acquisition operating models, vendor strategy (RPO, agencies, technology partners), and global governance.
• Employ and integrate data, automation, and AI responsibly to improve hiring outcomes and decision‑making.
• Partner with Communications and Marketing to strengthen external brand presence and storytelling.
• Provide strategic leadership and direction for the design and implementation of effective recruiting programs and methodologies.
• Plan and direct end to end talent acquisition lifecycle, including workforce planning support, recruiting, selection, offer management, and compliance.
• Develop innovative strategies to strengthen the employer brand to attract and engage candidates.
• Partner with hiring managers and HR Business Partners to plan on staffing needs while coaching leaders on their role for successful hiring outcomes.
• Develop recruiting metrics and reports to track performance trends and outcomes from recruiters.
• Manage recruiting vendors and tools.
• Manage a requisition on leadership roles and others as assigned.

Director, Talent Acquisition

Account Manager

• Increases sales and meet or exceed sales expectations through existing active relationships
• Builds new selling relationships in existing markets and expansion markets to grow the broker sales channel
• Manages provider relationships
• Oversees agent sales and product training including webinars for new agents
• Assists with broker support channels including customer service calls and email inquiries
• Ensures CMS compliance with all sales, enrollment processes and events

Broker Account Manager – Bilingual

Community Manager

• Meets or exceeds weekly and monthly qualified lead goals.
• Helps local market achieve monthly sales goals;
• Cultivates new and maintains existing relationships with key senior and community influencers
• Sets-up and attends monthly events and activities through in-person visits, via telephone contact, and through email, sources, plans.
• Distributes approved marketing and event materials.
• Educates the community on Alignment and its benefits, services, and contracted providers.
• Provides monthly calendar of their planned activities and ensures that all scheduled events filed.
• Conducts and leads advertised sales meetings in their territory.

Community Marketing Outreach Representative

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Risk Adjustment Provider Engagement Lead

Bilingual Spanish Nurse Case Manager – Care Transitions, RN, CA License

TeleSales Retention Representative, CA Licensed

Risk Adjustment Provider Engagement Lead

Corporate Compensation Consultant

Recruiting Coordinator – Temporary

Medical Director, Utilization Management

Senior Director, Delegate Oversight

Medical Director – Utilization Management

Senior AI & Data Scientist

Quality Assurance Specialist – Appeal & Grievance

Director, Talent Acquisition

Broker Account Manager – Bilingual

Community Marketing Outreach Representative

Bilingual Care Coordinator – Transition of Care