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 VP, General Manager serves as the senior leader responsible for driving the operational, financial, and strategic performance of assigned markets within Alignment Health Plan. This role advances Alignment Healthcare’s mission to transform senior care through compassionate service, innovative care models, and strong physician partnerships. The VP, General Manager oversees P&L strategy, market growth, quality performance, and regulatory compliance while optimizing provider networks and ensuring exceptional member experience. This leader builds high impact relationships with providers and community partners, drives 5 Star quality outcomes, and collaborates across the organization to achieve growth, retention, and cost of care goals in a fast growing, mission driven environment.

General Duties/Responsibilities (May include but are not limited to):

• Develop and execute the P&L strategy for assigned markets, ensuring achievement of financial performance, growth, and medical loss ratio (MLR) targets.
• Establish and operationalize predictive KPIs to improve forecasting, performance monitoring, and proactive management of market outcomes.
• Drive performance across CAHPS, HEDIS, and HOS measures with the goal of achieving and sustaining 5-Star ratings; ensure effective management of JSAs and AWVs to meet completion targets.
• Lead initiatives to improve MRA quality and coding accuracy while ensuring compliance with CMS regulatory requirements and quality program objectives.
• Design and execute strategies for optimal provider network development, expansion, and performance in both established and new markets.
• Lead the negotiation, implementation, and management of provider contracts, including IPAs/medical groups, hospitals, physicians, ancillary providers, and supplemental vendors.
• Develop and implement innovative contracting strategies and reimbursement models, including capitation, case rates, per diems, and value-based arrangements that improve quality and cost efficiency.
• Monitor market performance metrics and implement corrective actions to improve utilization, unit cost, quality outcomes, and operational effectiveness.
• Build and maintain strong relationships with key stakeholders, including physician leaders, provider organizations, hospitals, and community partners to advance market strategy and performance.
• Partner with cross-functional leadership to achieve growth, retention, financial, operational, and quality objectives while ensuring compliance with regulatory requirement.
   

Supervisory Responsibilities:

Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

10 years of experience in Medicare Advantage managed care

10 years of experience in contract negotiation strategies, reimbursement methodologies, contract language, financial modeling and analysis

10 years of managerial experience

Education/Licensure:

BA/BS Degree in business or a relevant field is required

MBA strongly preferred.

Other:

Must have strong experience in the Medicare Advantage managed care space, including but not limited to an understanding of CMS payment methodologies, risk adjustment, and Stars.  

Must have strong analytical skills and customer service skills.

Must have ability to develop and implement network strategies. Develop new analyses and approaches to using data that allow fresh insights into the company's business.

Strong experience with provider network management and market performance, with knowledge of the California market strongly preferred.

Strong experience with provider and health plan operations.

Experience with delegated and non-delegated providers.

Understanding of provider contracts for medical groups, independent physicians, ancillary providers and hospitals, including contract language and provider payment methodologies:  Hospitals (DRG, per diem), Physicians (RBRVS, FFS, Capitation), value based arrangements and provider incentives. 

Excellent knowledge of managed care finance

Excellent interpersonal and relationship management skills

Excellent oral, written and presentation skills and ability to convey complex or technical information in a manner that is readily understood by others. 

Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal.

Excellent Microsoft Office skills, including Word and Excel

30-50% travel by car or air

Available for evenings / weekends and extended work hours as needed

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay Range: $198,219.00 - $297,329.00

Pay 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.