Director, Preferred Networks & Care Routing

Alignment Health•Orange, CA

10d

About The Position

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 Director of Care Routing and Preferred Networks is a senior leader responsible for designing and operationalizing Alignment Healthcare’s care routing and preferred network strategies to ensure members are guided to high-performing providers while maintaining meaningful access to care. This role owns a member-centric approach to network intelligence and adequacy, ensuring the network is not only compliant with regulatory standards but appropriately structured to meet the clinical, geographic, and access needs of the population. Reporting into the AVP of Business Optimization, the Director integrates provider performance data, utilization trends, access analytics, and member demand signals to inform care routing decisions, preferred network strategies, and network optimization efforts. This leader partners closely with Network Management, Clinical Operations, Quality, Utilization Management, Analytics, and Technology teams to embed care routing and access logic into existing workflows and, where needed, establish targeted operational capabilities. In addition to strategic ownership, the Director will build and lead a small team responsible for network intelligence, care routing execution, and continuous evaluation of network adequacy as it relates to re-al-world member needs. The role requires strong judgment, data fluency, and operational design expertise to balance performance, access, and experience in a value-based care environment.

Requirements

Experience: 10+ years of experience in healthcare network management, clinical operations, access strategy, or value-based care environments.
5+ years of leadership experience managing teams or enterprise-level initiatives.
Demonstrated experience evaluating network adequacy, access, or provider capacity beyond regulatory compliance requirements.
Strong understanding of provider performance measurement, referral patterns, access standards, and utilization management.
Proven ability to translate data insights into operational workflows that influence care delivery and member access.
Experience operating effectively in complex, matrixed organizations.
Education: • Bachelor’s degree required in Healthcare Administration, Public Health, Business Administration, Nursing, or a related field.
Specialized Skills: Required: Deep understanding of healthcare provider networks, network adequacy, access standards, and care delivery models.
Strong analytical skills with the ability to synthesize access, utilization, and performance data into actionable strategies.
Ability to balance member access, provider performance, and operational feasibility in care routing decisions.
Strong communication and executive presence, with the ability to influence clinical, operational, and network stakeholders.
Experience designing and operationalizing workflows across clinical and non-clinical teams.
Comfort leading through ambiguity and building new capabilities.
Other: • Required: None Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Nice To Haves

Master’s degree preferred (e.g., MHA, MPH, MBA, MSN).
Preferred: Lean Six Sigma Black; PMP or Agile certification.

Responsibilities

Care Routing Strategy & Preferred Network Design Design and lead the enterprise care routing strategy, aligning provider selection and referral pathways with organizational goals for quality, affordability, access, and member experience.
Define and maintain preferred network frameworks that segment providers based on performance, capacity, access, and clinical outcomes.
Establish clear, data-driven criteria for identifying high-performing providers while ensuring adequate access for members across geographies and specialties.
Partner with Network Management to inform network strategy, provider engagement priorities, and prospective network development.
Network Intelligence & Member-Centric Network Adequacy Own the development of network intelligence capabilities that integrate claims, utilization, clinical outcomes, access, and member demand data.
Evaluate network adequacy beyond regulatory compliance measures, assessing whether the network meaningfully meets member needs related to access, capacity, timeliness, specialty coverage, and care continuity.
Identify gaps, redundancies, or misalignments in the network that may impact care routing effectiveness or member experience Provide data-driven recommendations to adjust network composition, provider mix, or geographic coverage based on performance and access insights.
Partner with Compliance and Network teams to ensure alignment between regulatory adequacy requirements and operational network realities.
Workflow Design & Operational Integration Design and embed care routing workflows within existing operational teams (e.g., UM, Care Management, Member Services, Provider Relations, Scheduling) to steer members to preferred providers while preserving access and choice.
Identify high-impact scenarios where proactive or facilitated care routing is required and develop scalable workflows to support those needs.
When appropriate, establish and lead a small team to directly facilitate care routing for targeted populations, services, or workflows.
Ensure care routing logic is operationally feasible, clinically appropriate, and supported by tools, data, and clear handoffs.
Cross-Functional Leadership & Strategic Influence Serve as the enterprise owner for care routing, preferred networks, and member-centric network adequacy strategy.
Influence enterprise decisions related to network design, access standards, clinical programs, and value-based care initiatives using network and performance insights.
Partner with Clinical, Quality, UM, Analytics, and Compliance leaders to align care routing with clinical appropriateness, regulatory expectations, and operational capabilities.
Support change management efforts to drive adoption of care routing strategies across teams and provider-facing functions.
Team Leadership & Capability Building Build, lead, and develop a small, high-performing team focused on network intelligence, care routing execution, and network adequacy analysis.
Establish clear performance goals, metrics, and accountability for the team.
Foster a culture of continuous improvement, collaboration, and data-driven decision-making.