Alignment Health

Remote Vietnamese Bilingual Customer Experience Specialist

Alignment Health · Full Time · 5 days ago

Alignment Health

🌎 United States 💵 $41600 - $57600 per year ⭐ 2-5 yrs exp 💼 Support

Deliver compassionate and seamless service to seniors and individuals with disabilities by resolving inquiries regarding benefits and eligibility. The role involves owning the member experience end-to-end and documenting all interactions to ensure continuity of care.

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Sr. Director, Risk Adjustment Data & Analytics (Remote)

Alignment Health · Full Time · 5 days ago

Alignment Health

🌎 United States 💵 $198K - $297K per year ⭐ 5-10 yrs exp 💼 Software Development

Lead the end-to-end Medicare Risk Adjustment data ecosystem, ensuring the integrity and completeness of data for submissions and reconciliation. Manage a multidisciplinary team of analysts and engineers to provide actionable insights and maintain audit readiness for senior leadership.

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RN Nurse Health Specialist (Remote | California RN License Required | Rotating Pacific Time Schedule)

Alignment Health · Full Time · 7 days ago

Alignment Health

🌎 United States 💵 $77905 - $116K per year ⭐ 2-5 yrs exp 💼 Healthcare

Serve as a frontline triage nurse providing telephonic and video-based clinical support to seniors and chronically ill patients. Collaborate with a multidisciplinary care team to develop care plans and prevent unnecessary hospitalizations.

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Physician Advisor (UM) - Part Time 1099 Must have CA License

Alignment Health · Full Time · 7 days ago

Alignment Health

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Physician Advisor performs clinical reviews for medical necessity and treatment appropriateness in compliance with CMS and Milliman guidelines. They collaborate with interdisciplinary teams to optimize institutional and outpatient services while overseeing quality outcomes and chronic disease management.

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Telehealth Coordinator, VCC

Alignment Health · Full Time · 7 days ago

Alignment Health

🌎 United States 💵 $41472 - $62208 per year ⭐ 0-2 yrs exp 💼 Healthcare

The Telehealth Coordinator provides day-to-day support for patients and providers in the Virtual Care Center, managing inbound and outbound calls. Key duties include scheduling virtual appointments, handling referrals, and providing systems training for new hires.

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UM Coordinator, Pre-Service (Remote | Pacific Time Schedule)

Alignment Health · Full Time · 7 days ago

Alignment Health

🌎 United States 💵 $41472 - $62208 per year ⭐ 2-5 yrs exp 💼 Others

The UM Coordinator supports the clinical team by processing clinical referrals and managing pre-service authorizations. Key duties include verifying eligibility, entering ICD-10/CPT codes, and coordinating medical documentation between providers and members.

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UM Nurse, Pre-service (Remote | California RN/LVN License Required | Sun - Thurs | Pacific Time Hours)

Alignment Health · Full Time · 8 days ago

Alignment Health

🌎 United States 💵 $77905 - $116K per year ⭐ 2-5 yrs exp 💼 Healthcare

Review prior authorization requests for medical necessity using CMS and Milliman Care Guidelines for inpatient and outpatient services. Collaborate with providers and medical directors to ensure high-quality, cost-effective care for senior members.

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UM Coordinator, Inpatient (Remote | Pacific Time Schedule)

Alignment Health · Full Time · 8 days ago

Alignment Health

🌎 United States 💵 $41472 - $62208 per year ⭐ 2-5 yrs exp 💼 Others

The UM Coordinator manages inpatient census, retrieves medical records, and assists with discharge planning. They are responsible for entering referral requests and authorizations using ICD-10 and CPT coding while maintaining member records.

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Coding Analyst, Care Delivery Organization - Fully remote

Alignment Health · Full Time · 9 days ago

Alignment Health

🌎 United States 💵 $58531 - $87797 per year ⭐ 2-5 yrs exp 💼 Others

Perform accurate HCC coding from member medical records and conduct structured coding audits for provider partners. Deliver targeted education to physicians and clinical staff to improve documentation quality and risk capture accuracy.

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Inpatient Review Nurse (Remote | California RN/LVN License Required | Pacific Time Schedule)

Alignment Health · Full Time · 9 days ago

Alignment Health

🌎 United States 💵 $77905 - $116K per year ⭐ 2-5 yrs exp 💼 Healthcare

Perform inpatient reviews to ensure patients receive the most appropriate and cost-effective level of care. Coordinate with physicians, case managers, and community resources to manage the continuum of care and post-discharge follow-up.

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Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)

Alignment Health · Full Time · 11 days ago

Alignment Health

🌎 United States 💵 $85696 - $128K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Lead UM Nurse reviews inpatient and prior authorization requests while overseeing a team of UM Nurses to ensure high-quality medical outcomes. They act as a liaison between management and staff, providing coaching, training, and operational support to maintain program compliance.

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Remote Manager, Care Management (CA RN Unrestricted License) 

Alignment Health · Full Time · 12 days ago

Alignment Health

🌎 United States 💵 $98550 - $147K per year ⭐ 5-10 yrs exp 💼 Healthcare

Lead and mentor a team of RN Case Managers to ensure high-quality outpatient care delivery and regulatory compliance. Oversee daily operations, including workload prioritization, staff onboarding, and cross-functional collaboration with medical leadership.

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Bilingual Vietnamese/Spanish Care Coordinator, SNP

Alignment Health · Full Time · 14 days ago

Alignment Health

🌎 United States 💵 $41472 - $62208 per year ⭐ 2-5 yrs exp 💼 Healthcare

Collaborate with RN Case Managers to coordinate care for SNP members, focusing on closing care gaps and managing referrals. Act as a primary point of contact for members to advocate for their care and maintain accurate documentation in the case management system.

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Remote Telephonic RN Case Manager–Special Needs Plan - Remote (California RN License Required) (Bilingual preferred)

Alignment Health · Full Time · 14 days ago

Alignment Health

🌎 United States 💵 $77905 - $116K per year ⭐ 2-5 yrs exp 💼 Healthcare

Provide telephonic case management for medically complex seniors, including conducting health assessments and creating individualized care plans. Coordinate with physicians and specialists to close gaps in care and educate members on preventive health.

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Field Remote Nurse Practitioner/ Physician Assistant (hospice/palliative care experience preferred)

Alignment Health · Full Time · 15 days ago

Alignment Health

🌎 United States 💵 $130K - $195K per year ⭐ 0-2 yrs exp 💼 Healthcare

Conduct in-home assessments, medication reviews, and health screenings for senior members to prevent unnecessary hospitalizations. Coordinate care plans with Regional Medical Officers, PCPs, and a multidisciplinary clinical team.

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Customer Success Lead

Alignment Health · Full Time · 19 days ago

Alignment Health

🌎 United States 💵 $44790 - $67185 per year ⭐ 2-5 yrs exp 💼 Sales

The Customer Success Lead manages complex and high-visibility member escalations while providing real-time guidance and coaching to frontline Specialists. This role balances direct member interaction with operational oversight to ensure high-quality service recovery and regulatory compliance.

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Regional Concierge Navigator (Bilingual in Spanish)

Alignment Health · Full Time · 19 days ago

Alignment Health

🌎 United States 💵 $44790 - $67185 per year ⭐ 0-2 yrs exp 💼 Others

The Regional Concierge Navigator provides outreach and support to members to help them navigate healthcare benefits and access necessary care. They act as a liaison between members, providers, and health plan operations to ensure coordinated care and resolve member issues.

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Remote-Senior Workforce Management Analyst

Alignment Health · Full Time · 19 days ago

Alignment Health

🌎 United States 💵 $77905 - $116K per year ⭐ 5-10 yrs exp 💼 Recruitment

Responsible for delivering advanced reporting, predictive insights, and operational intelligence for a 24/7 contact center. The role involves transforming complex data into actionable intelligence to drive service excellence and ensure CMS regulatory compliance.

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Remote-Customer Service Representative (Bilingual in Spanish)

Alignment Health · Full Time · 20 days ago

Alignment Health

🌎 United States 💵 $44790 - $67185 per year ⭐ 0-2 yrs exp 💼 Support

Provide specialized outreach and support to senior members to help them navigate healthcare benefits and access care. Coordinate between provider networks and health plan operations to ensure high-quality coordinated care and issue resolution.

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Complex Care Registered Nurse, must have AZ license

Alignment Health · Full Time · 20 days ago

Alignment Health

🌎 United States 💵 $79697 - $119K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Complex Care RN manages the clinical journey for high-acuity Medicare Advantage members within a virtual care pod. Key duties include coordinating transitions of care, performing medication reconciliations, and escalating clinical concerns to Advanced Practice Clinicians.

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Advanced Practice Clinician (NP/PA) hospice/palliative care experience preferred

Alignment Health · Full Time · 20 days ago

Alignment Health

🌎 United States 💵 $130K - $195K per year ⭐ 0-2 yrs exp 💼 Healthcare

The clinician conducts in-home assessments, medication reviews, and health screenings for senior patients to prevent unnecessary hospitalizations. They collaborate with medical officers and stakeholders to develop and lead comprehensive care plans for members.

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Complex Care Registered Nurse

Alignment Health · Full Time · 20 days ago

Alignment Health

🌎 United States 💵 $85696 - $128K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Complex Care RN manages the clinical journey for high-acuity Medicare Advantage members within a virtual care pod. Key duties include coordinating transitions of care, performing medication reconciliations, and escalating clinical concerns to providers.

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Sr. Technical Product Manager

Alignment Health · Full Time · 20 days ago

Alignment Health

🌎 United States 💵 $130K - $195K per year ⭐ 10+ yrs exp 💼 Product

Lead the product strategy and roadmap for Utilization Management capabilities and the AVA platform to improve clinical outcomes and operational efficiency. Drive AI-enabled automation and mentor product managers to elevate execution quality across the organization.

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Bilingual Spanish Telephonic RN Nurse Case Manager -Special Needs Plan (California RN Required)

Alignment Health · Full Time · 21 days ago

Alignment Health

🌎 United States 💵 $77905 - $116K per year ⭐ 2-5 yrs exp 💼 Healthcare

Provide telephonic case management for medically complex seniors, including conducting health assessments and creating individualized care plans. Coordinate with physicians and specialists to close gaps in care and educate members on disease management.

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Remote Customer Experience Specialist

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $41600 - $57600 per year ⭐ 2-5 yrs exp 💼 Support

Deliver compassionate, end-to-end service to seniors and individuals with disabilities by resolving inquiries regarding benefits, eligibility, and claims. The role involves managing high call volumes, documenting interactions in real-time, and advocating for members to ensure first-call resolution.

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Principal AI & Data Scientist (Remote)

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $198K - $297K per year ⭐ 10+ yrs exp 💼 Software Development

Define the technical strategy and architect enterprise-wide AI capabilities to support healthcare business goals. Lead the research and deployment of advanced ML solutions, including LLM agents and predictive engines, while establishing organizational standards for AI governance.

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Remote Customer Service Representative (Bilingual in Spanish)

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $44790 - $67185 per year ⭐ 2-5 yrs exp 💼 Support

Provide specialized outreach and support to senior members to help them navigate healthcare benefits and access care. Coordinate between provider networks and members while managing case follow-ups and resolving eligibility or pharmacy needs.

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Community Outreach Representative - Field Remote - Must live in San Joaquin, Merced or Stanislaus County

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $53210 - $79815 per year ⭐ 2-5 yrs exp 💼 Others

Act as a brand ambassador to generate qualified leads and build partnerships with community organizations to drive Medicare Advantage enrollment. Coordinate outreach events and educate prospective members on plan benefits while maintaining strict CMS compliance.

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Clinical Pharmacist I - Remote

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $113K - $169K per year ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for reviewing Part D coverage determinations and appeals to ensure compliance with CMS regulations and plan benefits. Conducts Medication Therapy Management (MTM) activities, including comprehensive medication reviews for high-risk senior members.

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Director, Marketing, Part D STARS

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $130K - $195K per year ⭐ 5-10 yrs exp 💼 Marketing

Lead the member marketing and communications strategy to drive performance improvement across key healthcare programs. Design and execute integrated multi-channel campaigns while collaborating with cross-functional teams to achieve organizational OKRs.

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Technical Product Manager - STARS

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $113K - $169K per year ⭐ 5-10 yrs exp 💼 Product

Drive the strategy, development, and execution of technical products from ideation through launch within a healthcare payer context. Bridge the gap between technical engineering teams and business stakeholders to ensure regulatory compliance and business value.

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Quality Retention Specialist (Required to work PST hours and live in North Carolina)

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $38569 - $57853 per year ⭐ 2-5 yrs exp 💼 Sales

The specialist manages member disenrollment requests and resolves escalated calls regarding healthcare processes and protocols. They are responsible for meeting monthly goals and collaborating with internal departments and vendors to improve the member experience.

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Telephonic RN Case Manager, SNP (Bilingual Preferred)

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $77905 - $116K per year ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for healthcare management and coordination for members with complex and chronic care needs via telephone. This includes conducting comprehensive assessments, collaborating with interdisciplinary teams, and closing gaps in care to improve member health.

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Senior Engineer & Data Architect, Financial Systems

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $130K - $195K per year ⭐ 10+ yrs exp 💼 Software Development

Design and maintain high-volume data pipelines connecting Oracle Cloud Financials to the enterprise data ecosystem and analytics platforms. Ensure financial data integrity, security, and compliance for executive reporting and regulatory submissions.

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Sr. Analyst, Financial Systems: Oracle EPM and FP&A

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $113K - $169K per year ⭐ 5-10 yrs exp 💼 Software Development

Responsible for the design, administration, and optimization of the Oracle EPM environment to support financial planning, budgeting, and forecasting. This role ensures data integrity between ERP and EPM systems while delivering advanced analytics and executive reporting for Finance leadership.

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Sr. Analyst, Financial Systems: Oracle GL and Financial Close

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $113K - $169K per year ⭐ 5-10 yrs exp 💼 Software Development

Serve as the technical subject matter expert for Oracle Cloud Financials' General Ledger and Financial Close environment to ensure stability and optimization. Manage system configurations, automate close processes, and ensure financial reporting meets US GAAP, SOX, and CMS regulatory standards.

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Sr. Director, Financial Systems

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $172K - $258K per year ⭐ 10+ yrs exp 💼 Finance

Lead the end-to-end implementation and operational management of the Oracle Cloud Financials platform. Act as the strategic bridge between Digital Technology Services and Finance to ensure scalable, compliant financial systems architecture.

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Financial Planning and Analysis Manager

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $109K - $164K per year ⭐ 5-10 yrs exp 💼 Finance

The FP&A Manager supports the Director and SVP in budgeting, forecasting, and financial reporting to monitor overall financial performance. Key duties include building complex financial models, analyzing corporate data, and preparing presentations for the Board of Investors.

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Senior AI Automation Engineer

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $172K - $258K per year ⭐ 5-10 yrs exp 💼 Software Development

Architect and deliver production-grade AI/ML systems and enterprise automation solutions to improve Medicare Advantage operations. Lead the design of LLM-powered applications and mentor junior engineers to elevate team engineering practices.

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Remote-Manager, Case Management SNP (California RN License Required)

Alignment Health · Full Time · a month ago

Alignment Health

🌎 United States 💵 $113K - $169K per year ⭐ 5-10 yrs exp 💼 Healthcare

Oversee the day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members. Ensure compliance with CMS Model of Care requirements while driving quality and member-centered outcomes.

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VP, Provider and Member Appeals & Grievances

Alignment Health · Full Time · 2 months ago

Alignment Health

🌎 United States 💵 $227K - $341K per year ⭐ 10+ yrs exp 💼 Others

Lead the strategic and operational functions of provider and member appeals, grievances, and CTM programs to ensure regulatory compliance. Manage a multi-layered leadership team and serve as the primary organizational voice to CMS and other regulatory bodies.

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VP, Compliance

Alignment Health · Full Time · 2 months ago

Alignment Health

🌎 United States 💵 $227K - $341K per year ⭐ 10+ yrs exp 💼 Legal

Lead and evolve the enterprise-wide Compliance Program for Medicare Advantage and other lines of business. Drive strategic regulatory guidance, HIPAA privacy governance, and a data-driven culture of ethics and integrity.

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Remote Outreach Concierge Navigator (Bilingual in Spanish)

Alignment Health · Full Time · 2 months ago

Alignment Health

🌎 United States 💵 $44790 - $67185 per year ⭐ 0-2 yrs exp 💼 Others

Provide specialized outreach and navigation support to senior members to ensure access to coordinated healthcare and benefits. Act as a liaison between members, providers, and health plan operations to resolve issues and schedule care.

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Care Management Trainer

Alignment Health · Full Time · 2 months ago

Alignment Health

🌎 United States 💵 $85696 - $128K per year ⭐ 2-5 yrs exp 💼 Teaching

Responsible for onboarding, training, and developing clinical and non-clinical Care Management staff through structured orientation and competency programs. Performs quality audits of calls and charts to provide coaching and ensure regulatory compliance.

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AVP, Contracting & Network Management

Alignment Health · Full Time · 2 months ago

Alignment Health

🌎 United States 💵 $172K - $258K per year ⭐ 10+ yrs exp 💼 Others

Develop and execute network strategies and manage provider contracts to create efficient healthcare delivery systems. Lead the implementation of reimbursement models and manage staff to support market growth and operational success.

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Sr. Territory Manage - Field Remote - Must live in San Bernardino/Inland Empire, CA

Alignment Health · Full Time · 2 months ago

Alignment Health

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Sr. Territory Manager is responsible for generating leads and meeting sales goals for new enrollments while retaining existing members. This involves building relationships with contracted providers and community affiliates through local area marketing and presentations.

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Bilingual Care Coordinator, Transition of Care (Remote, Mon-Fri, 8am-5pm Pacific Required)

Alignment Health · Full Time · 3 months ago

Alignment Health

🌎 United States 💵 $41472 - $62208 per year ⭐ 2-5 yrs exp 💼 Healthcare

Partner with RN case managers to support members through transitions of care following hospital or SNF discharges. Responsibilities include scheduling appointments, coordinating home health and DME services, and managing member documentation.

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Medical Director, Utilization Management

Alignment Health · Full Time · 3 months ago

Alignment Health

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Medical Director performs clinical reviews for medical necessity and treatment appropriateness while ensuring compliance with Medicare and CMS guidelines. They also collaborate with interdisciplinary teams to optimize service utilization and oversee quality outcomes.

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Regional Medical Officer

Alignment Health · Full Time · 5 months ago

Alignment Health

🌎 United States 💵 $262K - $393K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Regional Medical Officer directs clinical operations and financial outcomes within a region by maintaining and improving the clinical model, partnering with executive leadership to champion growth. Responsibilities also include managing budgets, analyzing performance data, overseeing clinical divisions, and executing direct patient care duties as needed.

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Physician Advisor, Utilization Management (CA License Required)

Alignment Health · · 5 months ago

Alignment Health

🌎 United States 💵 $198K - $297K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Physician Advisor optimizes the use of institutional and outpatient services for all patients while ensuring quality of care through clinical reviews for medical necessity and treatment appropriateness. Responsibilities include processing second-level reviews, acting as a liaison between medical staff and payers, and providing clinical leadership for quality projects.

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Provider Engagement Specialist – San Diego County (Field Remote)

Alignment Health · Full Time · 9 months ago

Alignment Health

🌎 United States 💵 $58531 - $87797 per year ⭐ 2-5 yrs exp 💼 Recruitment

The Provider Engagement Specialist is responsible for developing and maintaining strong relationships with provider offices to improve network performance and enhance provider satisfaction. This role partners with providers on strategies to increase patient retention and growth while driving performance across key quality and utilization metrics.

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