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.
Alignment Health
50 Remote Job Openings at Alignment Health
Lead enterprise strategic sourcing and supplier delivery activities to maximize value and meet organizational goals. Responsible for the overall procurement strategy, spend management, and transforming the organization into a centralized strategic function.
Bilingual Spanish Telephonic RN Nurse Case Manager -Special Needs Plan (California RN Required)
Alignment Health
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Full Time
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9 hours ago
Alignment Health
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.
The specialist conducts member outreach to help eligible seniors navigate clinical programs and schedule necessary healthcare appointments. They are responsible for real-time documentation and collaborating with clinical departments to improve member healthcare outcomes.
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.
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.
Remote Customer Service Representative (Bilingual in Spanish)
Alignment Health
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Full Time
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6 days ago
Alignment Health
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.
Community Outreach Representative - Field Remote - Must live in San Joaquin, Merced or Stanislaus County
Alignment Health
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Full Time
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6 days ago
Alignment Health
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.
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.
Remote Bilingual Spanish Telephonic RN Nurse Case Manager (California RN Required)
Alignment Health
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Full Time
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6 days ago
Alignment Health
Provide telephonic case management for medically complex seniors, including conducting health assessments and creating individualized care plans. Coordinate with healthcare partners to close gaps in care and educate members on disease management.
Develop and deploy production-grade AI/ML models to enhance risk score accuracy and clinical documentation review on a proprietary intelligence platform. Partner with cross-functional leaders to embed data science into healthcare workflows such as claims processing and utilization management.
Perform quality assessment audits of internal coding analysts and vendors to ensure accurate data submission to CMS. Analyze audit results to identify opportunities for training, data integrity, and process improvement.
Risk Adjustment Compliance Auditor (Remote)
Alignment Health
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Full Time
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7 days ago
Alignment Health
Conduct provider and coder-level audits to ensure the accuracy of risk adjustment data submitted to CMS. Monitor coding prevalence, identify compliance risks, and support RADV audit initiatives and corrective action plans.
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.
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.
Bilingual Care Coordinator, Outpatient Case Management (Remote, Mon-Fri, 8am-5pm Pacific Required)
Alignment Health
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Full Time
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7 days ago
Alignment Health
Coordinate services and close care gaps for seniors with complex health needs in collaboration with RN case managers. Handle referrals, authorizations, appointment scheduling, and member outreach to ensure timely care delivery.
Quality Retention Specialist (Required to work PST hours and live in North Carolina)
Alignment Health
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Full Time
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10 days ago
Alignment Health
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.
Execute detailed claims audits to ensure compliance with CMS and contractual requirements for delegated entities. Collaborate with cross-functional teams to develop and validate Corrective Action Plans to improve operational performance.
Telephonic RN Case Manager, SNP (Bilingual Preferred)
Alignment Health
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Full Time
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14 days ago
Alignment Health
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.
Remote-Bilingual Spanish Resolution Specialist
Alignment Health
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Full Time
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14 days ago
Alignment Health
The specialist manages and resolves complex healthcare insurance claims and member issues to improve the overall member experience. They serve as a subject matter expert for escalated calls and identify process improvement opportunities within the member engagement department.
Senior Engineer & Data Architect, Financial Systems
Alignment Health
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Full Time
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16 days ago
Alignment Health
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.
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.
Sr. Analyst, Financial Systems: Oracle EPM and FP&A
Alignment Health
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Full Time
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16 days ago
Alignment Health
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.
Sr. Analyst, Financial Systems: Oracle GL and Financial Close
Alignment Health
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Full Time
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16 days ago
Alignment Health
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.
Remote Manager, Care Management (CA RN Unrestricted License)
Alignment Health
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Full Time
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16 days ago
Alignment Health
Lead and mentor a team of RN Case Managers to ensure high-quality outpatient care delivery and regulatory compliance. Oversee daily operations including referrals, transitions of care, and the analysis of clinical data for continuous improvement.
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.
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.
Define and execute the enterprise AI and automation strategy to improve care quality and operational performance for Medicare Advantage business. Lead a multi-disciplinary engineering team to design and scale AI-powered systems while ensuring regulatory compliance.
Remote-Manager, Case Management SNP (California RN License Required)
Alignment Health
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Full Time
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22 days ago
Alignment Health
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.
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.
VP, Provider and Member Appeals & Grievances
Alignment Health
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Full Time
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a month ago
Alignment Health
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.
Remote Outreach Concierge Navigator (Bilingual in Spanish)
Alignment Health
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Full Time
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a month ago
Alignment Health
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.
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.
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.
Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)
Alignment Health
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Full Time
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2 months ago
Alignment Health
The Lead UM Nurse reviews inpatient and prior authorization requests to ensure high-quality medical outcomes at the appropriate level of care. They oversee a team of UM Nurses, providing clinical guidance, coaching, and operational support to maintain program compliance.
Sr. Territory Manage - Field Remote - Must live in San Bernardino/Inland Empire, CA
Alignment Health
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Full Time
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2 months ago
Alignment Health
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.
Remote Bilingual Spanish Nurse Case Manager – Care Transitions (RN, CA License)
Alignment Health
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Full Time
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2 months ago
Alignment Health
Coordinate safe transitions for patients moving from hospitals or skilled nursing facilities back to their homes. Create individualized discharge plans and collaborate with providers, rehab facilities, and home health agencies.
Bilingual Care Coordinator, Transition of Care (Remote, Mon-Fri, 8am-5pm Pacific Required)
Alignment Health
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Full Time
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2 months ago
Alignment Health
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.
Medical Director, Utilization Management
Alignment Health
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Full Time
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2 months ago
Alignment Health
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.
The Senior Director is responsible for the vision, strategy, and performance of the enterprise delegated oversight function, ensuring compliance and value-based care outcomes. They lead cross-functional teams and manage executive relationships with delegated partners to mitigate risk and drive organizational growth.
Advanced Practice Clinician Temp (NP/PA), Care Anywhere
Alignment Health
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Full Time
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3 months ago
Alignment Health
The Advanced Practice Clinician will conduct in-home assessments, medication reviews, and health screenings for Alignment Health members. They will also coordinate care plans with multidisciplinary teams and stakeholders to prevent unnecessary hospitalizations and manage disease progression.
Advanced Practice Clinician (NP/PA) JSA (Must be able to conduct home visits, South San Diego preferred)
Alignment Health
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Full Time
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3 months ago
Alignment Health
The Advanced Practice Clinician conducts comprehensive in-home assessments for senior patients, including physical exams, medication reviews, and chronic disease management. They work within an interdisciplinary team to coordinate care, identify gaps in service, and provide education to patients and their families.
Advanced Practice Clinician, (NP/PA) JSA (must be able to conduct home visits) North LA / Ventura preferred.
Alignment Health
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Full Time
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3 months ago
Alignment Health
Conduct comprehensive in-home assessments for senior patients, including physical exams, medication reviews, and chronic disease management. Collaborate with an interdisciplinary team to coordinate care and communicate findings to primary care physicians.
Sr. Director, Risk Adjustment Data & Analytics
Alignment Health
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Full Time
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3 months ago
Alignment Health
The Sr. Director leads the end-to-end Medicare Risk Adjustment data ecosystem, ensuring data integrity and strategic value for clinical and financial workflows. They manage a multidisciplinary team of analysts and engineers to drive program performance, audit readiness, and actionable executive insights.
Remote Vietnamese Bilingual Customer Experience Specialist
Alignment Health
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Full Time
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4 months ago
Alignment Health
The specialist is responsible for delivering compassionate, seamless service to members, focusing on building caring connections, owning the end-to-end member experience, and resolving issues completely and correctly, often on the initial contact. Duties include accurately responding to inquiries about benefits, providers, and claims, while thoroughly documenting all interactions and proactively addressing complaints.
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.
Physician Advisor, Utilization Management (CA License Required)
Alignment Health
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5 months ago
Alignment Health
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.
Director, Preferred Networks & Care Routing
Alignment Health
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Full Time
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5 months ago
Alignment Health
This senior leader is responsible for designing and operationalizing the enterprise care routing and preferred network strategies to guide members to high-performing providers while ensuring meaningful access to care. The role involves integrating various data sources to inform strategy, embedding logic into workflows, and building/leading a small team focused on network intelligence and adequacy evaluation.
Advanced Practice CLinician (NP/PA) Must be able to conduct home visits in County
Alignment Health
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Full Time
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5 months ago
Alignment Health
The Advanced Practice Clinician will conduct in-home assessments and coordinate care for patients with complex and chronic needs. They will work within an interdisciplinary team to ensure quality and cost-effective patient care.
Provider Engagement Specialist – San Diego County (Field Remote)
Alignment Health
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Full Time
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9 months ago
Alignment Health
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.
