Alignment Health

Compensation

Full Description

Job Description: • Develop and execute a comprehensive clinical transformation strategy that supports medical cost management, quality performance (e.g., STAR ratings, HEDIS, CAHPS), and member engagement goals. • Design, implement, and continuously refine evidence-based clinical programs and interventions targeting key disease states, utilization patterns, and population health priorities. • Collaborate with Regional Medical Directors, Operations, Pharmacy, Network, and Analytics teams to identify opportunities for clinical innovation and improvement. • Lead the translation of clinical insights into operationally executable programs that drive measurable outcomes. • Lead cross-functional initiatives integrating clinical operations, population health, risk adjustment, and quality improvement programs. • Oversee end-to-end lifecycle of clinical programs — from concept design through pilot, rollout, evaluation, and scaling. • Establish program KPIs and outcomes measurement frameworks; monitor performance and ensure continuous quality improvement. Requirements: • 10+ years of progressive leadership experience in managed care, health plan operations, or population health management • Deep understanding of Medicare Advantage regulations, STARS and HEDIS metrics, and value-based care models. • Proven track record of developing and implementing scalable clinical programs that improve outcomes and reduce total cost of care. • Experience leveraging analytics and technology to drive clinical and operational improvement. • Strong familiarity with utilization management, care management, and risk adjustment functions. • Master’s degree in Healthcare Administration, Public Health, or related field. Benefits: • Alignment Health is an Equal Opportunity/Affirmative Action Employer.