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.
Alignment Health
68 Remote Job Openings at Alignment Health
Provider Dispute Resolution Coordinator - Fully remote
Alignment Health
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Full Time
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3 hours ago
Alignment Health
Provide clerical support to the Provider Dispute Resolution team, including data entry and managing correspondence. Coordinate with providers and delegated entities to obtain necessary documentation for disputes and appeals.
Financial Planning and Analysis Manager
Alignment Health
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Full Time
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21 hours ago
Alignment Health
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.
Remote Bilingual Spanish Telephonic RN Nurse Case Manager (California RN Required)
Alignment Health
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Full Time
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3 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.
VP, Provider and Member Appeals & Grievances
Alignment Health
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Full Time
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5 days 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.
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.
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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5 days ago
Alignment Health
As an RN Case Manager, you will provide telephonic case management to medically complex and chronically ill members. You will conduct health assessments, create care plans, and coordinate care with various partners.
Lead the performance management process for delegated entities by synthesizing audit and operational data into actionable improvement strategies. Drive structured performance discussions with partners to ensure accountability and sustained operational improvement across clinical and claims functions.
Remote Outreach Concierge Navigator (Bilingual in Spanish)
Alignment Health
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Full Time
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10 days 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 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 regulatory compliance.
Utilization Management Physician Advisor, CA Licensed (Part Time)
Alignment Health
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Full Time
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14 days ago
Alignment Health
Perform medical necessity and utilization reviews for inpatient, outpatient, and post-acute cases to optimize service use and ensure quality of care. Act as a clinical leader and liaison between medical staff and the utilization review team to improve member outcomes.
Broker Account Manager - Field Remote - Fresno and Madera, CA
Alignment Health
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Full Time
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16 days ago
Alignment Health
The Broker Account Manager is responsible for driving sales growth and managing the broker channel, including recruitment, training, and strategy. They ensure CMS compliance and maintain strong relationships with external agents and medical groups.
Remote Senior Director, Nurse Practitioners and PAs
Alignment Health
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Full Time
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17 days ago
Alignment Health
Lead and optimize the performance and integration of the Advanced Practice Clinician team across multi-state markets. Drive clinical excellence, innovation, and operational performance to improve quality outcomes and reduce avoidable utilization.
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.
Remote-Supervisor, Customer Reimbursement and Digital
Alignment Health
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Full Time
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23 days ago
Alignment Health
Lead and coach a team of specialists handling digital member communications and reimbursement processing to ensure operational excellence. Translate strategic priorities into daily execution while maintaining regulatory compliance and high member satisfaction.
Provides operational and clinical support for Medicare Part D programs, focusing on formulary management, compliance, and PBM oversight. Responsible for rendering coverage determinations, conducting MTM services, and leading provider and member outreach.
Responsible for reviewing Part D coverage determinations and appeals to ensure compliance with CMS regulations and plan benefits. Conducts Medication Therapy Management (MTM) activities and comprehensive medication reviews to improve care for high-risk senior members.
TeleSales Retention Representative - Remote in CA - Must be licensed in CA
Alignment Health
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Full Time
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24 days ago
Alignment Health
The representative is responsible for generating leads to meet sales production goals for new enrollments and retaining existing members. Duties include handling inbound inquiries, conducting outbound campaigns, and ensuring compliance with federal and state regulations.
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.
The Customer Success Lead manages complex and high-visibility member escalations to ensure timely resolution and service recovery. They also provide real-time guidance and coaching to frontline Specialists while monitoring team performance and compliance.
Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)
Alignment Health
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Full Time
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a month 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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a month 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.
Deliver compassionate, end-to-end service to seniors and individuals with disabilities by resolving inquiries regarding benefits, eligibility, and claims. Document all interactions in real-time and proactively address member grievances to ensure first-call resolution.
Remote Nurse Health Specialist (Must have California RN License)
Alignment Health
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Full Time
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a month ago
Alignment Health
Provide triaging services and medical support for senior patients via a 24/7 virtual care center to prevent unnecessary hospitalizations. Collaborate with physicians and advanced practice clinicians to manage patient care and develop comprehensive care plans.
Remote-Resolution Specialist (Spanish Bilingual)
Alignment Health
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Full Time
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a month ago
Alignment Health
Manage and resolve complex member issues regarding claims, authorizations, and benefits through proactive outreach and cross-functional coordination. Ensure all cases are documented accurately and resolved within defined turnaround times to improve the member experience.
Lead enterprise communications initiatives, including social media, public relations, and ESG, to ensure consistent messaging across the organization. Coordinate executive messaging and partner with cross-functional teams to align communications with strategic priorities and regulatory requirements.
Remote Vice President, Market Operations
Alignment Health
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Full Time
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a month ago
Alignment Health
Provide executive oversight of market operations to ensure enterprise-wide consistency, scalability, and financial performance across all geographies. Lead the evolution of the market operating model and drive improvements in medical cost management, Stars performance, and member experience.
Remote Customer Service Representative (Bilingual in Spanish)
Alignment Health
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Full Time
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a month ago
Alignment Health
The Remote Regional Concierge Navigator provides outreach and support to members to help them navigate healthcare benefits and access care. Responsibilities include conducting welcome calls, scheduling provider appointments, and resolving eligibility or pharmacy issues.
Remote Bilingual Spanish Nurse Case Manager – Care Transitions (RN, CA License)
Alignment Health
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Full Time
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a month 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.
The HR Generalist manages employee relations cases, conducts workplace investigations, and provides guidance on performance issues and policy compliance. They act as a trusted advisor to managers to resolve conflicts and foster a positive work environment.
Sr. Territory Manager - Field Remote - Los Angeles, CA - Must be Bilingual
Alignment Health
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Full Time
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a month 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.
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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a month 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.
Architect and deliver production-grade AI/ML solutions for healthcare challenges such as risk stratification and fraud detection. Own the full ML lifecycle from experimentation to deployment while mentoring data scientists and partnering with cross-functional leaders.
Broker Account Manager - Field Remote - Bakersfield, CA
Alignment Health
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Full Time
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a month ago
Alignment Health
The Broker Account Manager is responsible for driving sales growth and managing the broker channel through recruitment, training, and strategic relationship management. They ensure all sales activities and enrollment processes remain compliant with CMS guidelines.
Lead the health plan's risk stratification, predictive modeling, and financial analytics agenda to improve quality and affordability. Manage a high-performing analytics team to translate complex data into operational actions and predictive KPIs.
Design and develop big data ingestion processes and ETL/ELT pipelines to support organizational initiatives. Collaborate with data scientists and analysts to provide scalable data infrastructure and maintain technical documentation.
Design and develop cloud-based BI and analytics services using the Microsoft BI Platform and Azure. Translate business requirements into technical specifications to create dynamic dashboards and optimize stored procedures for data reporting.
Physician Advisor (UM) - Part Time 1099 Must have CA License
Alignment Health
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Full Time
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a month ago
Alignment Health
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 providing clinical oversight for quality programs.
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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a month ago
Alignment Health
Act as a brand ambassador to generate qualified leads through community events and partnerships with senior-focused organizations. Coordinate with sales agents to convert engagement into Medicare Advantage enrollments while ensuring strict compliance with CMS guidelines.
The Data Scientist will develop and deploy production-grade AI/ML models to support clinical intelligence, risk adjustment, and documentation integrity. They will partner with cross-functional teams to translate complex healthcare problems into scalable, automated solutions.
Field Remote Medical Assistant (Las Vegas, NV)
Alignment Health
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Full Time
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a month ago
Alignment Health
The Field Remote Medical Assistant provides clinical and administrative support to clinicians during patient examinations and treatments. Responsibilities include managing patient check-in and check-out processes, recording vital signs, and administering prescribed medications.
Field Remote Medical Assistant (Phoenix, AZ)
Alignment Health
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Full Time
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a month ago
Alignment Health
The Field Remote Medical Assistant provides clinical and administrative support to clinicians during patient examinations and treatments. Responsibilities include managing patient check-in and check-out, recording vital signs, and administering prescribed medications.
Field Remote Medical Assistant (Reno, NV)
Alignment Health
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Full Time
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a month ago
Alignment Health
The Field Remote Medical Assistant provides clinical and administrative support to clinicians, including rooming patients and recording vital signs. They are also responsible for front office duties such as scheduling appointments, managing medical records, and processing patient check-ins and check-outs.
Field Remote Medical Assistant (Santa Cruz, AZ)
Alignment Health
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Full Time
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a month ago
Alignment Health
The Medical Assistant provides clinical and administrative support to clinicians, including patient intake, vital sign measurement, and treatment assistance. They are also responsible for front office duties such as scheduling appointments, managing medical records, and handling patient check-in and check-out processes.
Remote Director, Pharmacy Quality & Part D Stars
Alignment Health
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Full Time
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a month ago
Alignment Health
The Director will design and lead pharmacy initiatives to advance Part D Star Ratings and pharmacy quality measures. They are responsible for overseeing PBM and vendor performance while driving cross-functional collaboration to improve member outcomes.
Care Coordinator, Care Anywhere (Remote AZ, CA, NV | Bilingual Spanish | Medical Assistant)
Alignment Health
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Full Time
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a month ago
Alignment Health
The Care Coordinator manages provider schedules, prepares charts for home visits, and conducts high-volume outbound outreach to coordinate care for high-risk members. They also handle medical record documentation in the EMR, submit referral authorizations, and assist the nurse practitioner team with visit preparation.
Medical Director, Utilization Management
Alignment Health
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Full Time
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a month 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.
Architect and deploy end-to-end AI/ML solutions for complex healthcare challenges while managing the full machine learning lifecycle. Collaborate with cross-functional leaders to drive technical excellence and mentor data scientists to deliver measurable business outcomes.
Remote-Customer Service Representative (Bilingual in Spanish)
Alignment Health
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Full Time
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2 months ago
Alignment Health
The Regional Concierge Navigator provides outreach and support to members, helping them navigate healthcare benefits and provider networks. They are responsible for resolving member issues, scheduling appointments, and ensuring coordinated care throughout the member's journey.
Advanced Practice Clinician Temp (NP/PA), Care Anywhere
Alignment Health
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Full Time
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2 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.
Community Marketing Outreach Representative - Field Remote - Must live in LA County, San Fernando Valley or Ventura
Alignment Health
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Full Time
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2 months ago
Alignment Health
The Community Marketing Outreach Representative generates brand awareness and drives leads by building relationships with community influencers and hosting educational events. They are responsible for meeting sales goals and educating the public on health plan benefits and services.
Community Outreach Representative - Field Remote - Must live in Charlotte, NC
Alignment Health
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Full Time
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2 months ago
Alignment Health
The Community Outreach Representative is responsible for generating local brand awareness and driving leads through grassroots community events and relationship building. They act as the face of the health plan, conducting sales meetings and educating the community on available benefits and services.
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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2 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.
Broker Account Manager - Field Remote - Charlotte, NC
Alignment Health
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Full Time
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2 months ago
Alignment Health
The Broker Account Manager is responsible for driving sales growth within the broker channel by managing relationships, recruitment, and training. They must ensure all sales activities and enrollment processes remain in strict compliance with CMS guidelines.
The Principal AI & Data Scientist will architect enterprise-wide AI platforms and lead the development of advanced machine learning solutions to support clinical and operational goals. This role involves defining technical strategy, mentoring teams, and driving innovation in healthcare AI through research and production-ready deployments.
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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2 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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2 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.
The Sr. Compensation Analyst designs and maintains compensation programs with a focus on stock administration and executive compensation. This role also drives job architecture enhancements and ensures compliance with regulatory standards while partnering with HR and business leaders.
Remote Vietnamese Bilingual Customer Experience Specialist
Alignment Health
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Full Time
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3 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.
Telephonic RN Case Manager – Special Needs Plan (California RN License Required) Bilingual preferred
Alignment Health
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Full Time
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3 months ago
Alignment Health
The RN Case Manager will provide telephonic case management to medically complex and chronically ill members, conducting comprehensive health assessments and developing individualized care plans. This role involves coordinating care with internal and external partners, educating members/caregivers, monitoring progress, and resolving access issues.
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.
Manager, Compliance & Delegate Oversight Reporting and Analytics
Alignment Health
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Full Time
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3 months ago
Alignment Health
This role serves as the analytical and reporting leader, owning the framework for monitoring internal operations and delegated entities to ensure regulatory alignment and accountability. The manager will be a hands-on contributor developing reports, dashboards, and analytics while also leading a team of analysts.
Physician Advisor, Utilization Management (CA License Required)
Alignment Health
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4 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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4 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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4 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.
The Regional Concierge Navigator provides outreach and support to members, ensuring access to care and navigating healthcare benefits. They connect members with providers and assist in scheduling appointments and resolving issues.
Provider Engagement Specialist – San Diego County (Field Remote)
Alignment Health
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Full Time
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8 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.
