Regional Medical Director, Health Plan

Alignment Healthcare•Orange, CA

6d•Hybrid

About The Position

Alignment Health is seeking a physician leader to serve as the Regional Medical Director. This role is responsible for improving clinical, quality, utilization, risk adjustment, and financial performance across assigned provider networks and geographic markets. The Regional Medical Director will partner closely with various internal teams and external providers to create and execute strategies that enhance MLR, Stars performance, member outcomes, and value-based care results. This position acts as a trusted advisor to providers and health systems, using data-driven insights, clinical expertise, and strong relationships to drive accountability, performance improvement, and market success.

Requirements

Minimum 5 years of clinical practice experience
Minimum 3–5 years of leadership experience within managed care, Medicare Advantage, physician organizations, IPA/MSO, or value-based care environments
MD or DO degree from an accredited institution
Board certification in an ABMS or AOA-recognized specialty
Active, unrestricted medical license in applicable state(s)
Demonstrated working knowledge of Medicare Advantage operations, managed care principles, and CMS regulatory requirements applicable to utilization management, quality, and population health
Medicare Advantage and Managed Care Operations (Advanced): Comprehensive knowledge of Medicare Advantage operations, utilization management, risk adjustment, Stars, HEDIS, and value-based care performance metrics — with the ability to apply this knowledge to market-level provider engagement and performance improvement.
Clinical and Operational Data Analysis (Advanced): Ability to interpret complex clinical, financial, and quality performance data; identify root causes of performance variation; and translate findings into actionable, provider-facing improvement strategies.
Provider Engagement and Relationship Management (Advanced): Demonstrated experience working collaboratively with physicians, provider groups, and executive stakeholders to influence performance, drive operational change, and build sustainable clinical partnerships.
Utilization Management and Medical Expense Analysis (Advanced): Working knowledge of inpatient/outpatient utilization trends, site-of-service optimization, readmission drivers, and medical expense management — and the ability to lead corrective action planning in response to adverse trends.
Quality and Stars Improvement (Advanced): Knowledge of HEDIS, CAHPS, HOS, and Stars program requirements — and proven ability to translate quality performance data into targeted, market-level provider engagement strategies that close gaps and improve scores.
Communication and Executive Presentation (Advanced): Excellent written, verbal, and presentation skills — with the ability to communicate complex clinical and financial findings clearly to diverse audiences including providers, market leadership, and executive stakeholders.
Cross-Functional Collaboration (Advanced): Proven ability to operate effectively in matrixed environments — partnering across utilization management, care management, quality, risk adjustment, analytics, and operational teams to drive aligned execution.
Active, unrestricted MD or DO medical license in applicable state(s)
Board certification in an ABMS or AOA-recognized specialty

Nice To Haves

Experience supporting delegated provider groups, IPAs, ACOs, or risk-bearing entities
Experience in value-based contracting and provider performance optimization
Prior leadership experience supporting Medicare Stars improvement initiatives
Familiarity with clinical analytics, utilization trending, and provider scorecard methodologies
Board certification in Family Medicine or Internal Medicine
Formal training in quality improvement methodologies, population health management, or managed care operations
Familiarity with HEDIS, Stars, risk adjustment, and value-based care performance frameworks
Board certification in Family Medicine or Internal Medicine

Responsibilities

Serve as the physician leader supporting performance across assigned markets and provider networks.
Maintain a deep understanding of local provider landscapes, referral patterns, market dynamics, and local operational challenges impacting performance within their region.
Build collaborative relationships with providers to promote alignment around managed care principles, population health strategies, quality improvement initiatives, and value-based care performance.
Partner with Network Management and network providers to improve quality, affordability, risk adjustment, Stars, member experience, and overall value-based care performance.
Lead provider-facing discussions, performance reviews, and action planning efforts to drive accountability and measurable outcomes.
Act as a trusted clinical advisor to provider groups, IPAs, health systems, and internal stakeholders.
Analyze clinical, operational, financial, utilization, and quality data to identify performance gaps and improvement opportunities.
Develop and support market-specific strategies that improve MLR, utilization, quality outcomes, care coordination, and population health performance.
Collaborate with providers and provider organizations to implement evidence-based interventions that improve efficiency, consistency of care, and member outcomes.
Monitor performance against established goals and adjust strategies as needed to achieve sustainable results.
Partner with provider organizations and internal teams to improve documentation accuracy, risk adjustment performance, chronic disease management, and preventive care outcomes.
Support provider engagement efforts focused on improving Stars, HEDIS, CAHPS, HOS, medication adherence, and care gap closure.
Promote population health strategies that improve member outcomes while supporting organizational objectives.
Collaborate with Network Management, Risk Adjustment, Quality, Pharmacy, Care Management, Utilization Management, Analytics, and Operations teams to align improvement strategies and execution efforts.
Support value-based care initiatives, provider performance programs, and other enterprise priorities.
Participate in market, provider, and organizational committees, workgroups, and strategic initiatives as assigned.
Maintain knowledge of Medicare Advantage, CMS, and applicable regulatory requirements impacting provider performance, quality, medical management, and population health.
Serve as a visible physician leader within the market, fostering strong provider relationships and supporting Alignment's value-based care strategy.
Other duties as assigned.