VP, General Manager (OC)

Alignment Health•Orange, CA

6d•$198,219 - $297,329

About The Position

The Vice President / Orange County General Manager is the senior local business leader responsible for developing and executing Alignment Health’s Medicare Advantage business in Orange County and for its operational performance and financial results. The role turns market strategy into business plans, financial objectives, operational priorities, and disciplined execution. Its primary value drivers are membership growth and retention; STARS and quality; compliant risk adjustment and revenue integrity; provider and hospital performance; and market profitability, with an MLR target of 87% or less subject to quality, access, and regulatory requirements. The role shares market strategy, enterprise alignment, strategic priorities, and resource allocation with the VP, Market President, the Chief of Contracting and Market Management, and the company President. Reporting to the VP, Market President, with a dotted line to the Chief of Contracting, the VP/OC GM is the designated Responsible executive for integrated local market execution under formal RACI governance. The position works closely with Sales and other functional leaders and operates with local business ownership within approved decision rights. The executive leads Orange County business planning and P&L execution; coordinates cross-functional initiatives; drives membership growth, retention, quality, risk adjustment, provider and hospital performance, and medical cost management; and maintains financial forecasts and recovery plans. The role also leads local teams and matrixed partnerships, develops talent, manages stakeholder relationships, and ensures market initiatives comply with CMS, state, contractual, and enterprise requirements. Additional duties may be assigned.

Requirements

At least 12 years of progressive leadership in Medicare Advantage, managed care, health plan operations, market management, provider network management, or related fields.
At least 7 years leading complex market-level teams and cross-functional initiatives.
Demonstrated responsibility for P&L execution, medical economics, growth, provider performance, and operational outcomes.
Significant Medicare Advantage experience in risk adjustment, STARS, medical cost, delegated arrangements, and value-based care.
Experience building business plans, leading financial reviews, and delivering corrective actions.
Bachelor’s degree or equivalent combination of education and relevant experience.
Strong general management, financial ownership, forecasting, budgeting, and performance management capabilities.
Expert knowledge of Medicare Advantage economics, STARS, RAF, provider performance, and medical cost.
Ability to turn strategy into plans, RACI governance, measurable outcomes, and sustained execution.
Ability to influence senior executives and matrixed teams without direct reporting authority.
Knowledge of provider contracts, shared risk, hospital economics, and clinical utilization.
Excellent executive communication, negotiation, problem-solving, and analytical skills.
Proficiency in Microsoft Office and business intelligence/analytics tools.
Travel by car or air as business needs require; evening, weekend, or extended hours may be required.

Nice To Haves

Market general manager, regional business leader, or equivalent P&L-oriented executive experience.
MBA, MHA, MPH, JD, or related advanced degree.

Responsibilities

Lead the annual Orange County Medicare Advantage business plan in alignment with enterprise strategy and the Market President’s direction.
Translate P&L targets into initiatives, owners, milestones, forecasts, and measurable deliverables; own daily execution of approved plans for revenue, medical expense, MLR, membership, quality, risk adjustment, and provider economics.
Develop business plans by provider, hospital, geography, product, and membership segment; maintain a market scorecard and lead monthly performance reviews and corrective actions.
Escalate material financial, regulatory, contractual, and execution risks with recommended recovery plans; deliver approved financial results and an MLR of 87% or less.
Establish formal RACI governance for market initiatives and serve as the Responsible executive coordinating integrated execution across Sales, Product, Network, Contracting, Finance, Actuarial, Clinical, Quality, Risk Adjustment, Pharmacy, Operations, Member Experience, and Compliance.
Maintain initiative roadmaps with resources, dependencies, deadlines, financial impact, and deliverables; conduct weekly execution, monthly performance, and quarterly strategic reviews.
Hold local and functional leaders accountable for documented commitments, resolve barriers within delegated authority, and escalate unresolved issues.
Lead local growth and retention execution with Sales, Product, Marketing, Broker Distribution, and provider leadership; set growth objectives by product, provider, channel, geography, and member segment.
Identify market share opportunities, provider partnerships, and product differentiation; align network capacity, access, service, and member experience with enrollment and retention.
Monitor enrollment, disenrollment, retention, and competitor trends and initiate recovery plans; ensure provider-related marketing and referral initiatives comply with CMS requirements.
Own local execution of approved STARS and quality plans with enterprise teams and providers; set provider-specific objectives for HEDIS, CAHPS, HOS, medication adherence, preventive care, and applicable measures.
Coordinate clinicians and provider groups to close care gaps and improve outcomes; embed quality scorecards, corrective actions, and compliant incentives in provider operating reviews; monitor and address underperformance.
Lead local risk adjustment and revenue integrity execution with Risk Adjustment, Clinical, Compliance, Finance, and provider teams; build plans for accurate documentation, appropriate diagnosis recapture, and complete encounter submissions.
Monitor RAF, coding accuracy, assessment completion, and provider-level variation; coordinate timely, clinically appropriate assessments and address workflow and submission barriers.
Ensure diagnosis reporting is supported by valid clinical documentation and never incentivize unsupported diagnoses.
Own executive relationships with major Orange County IPAs, physician groups, hospitals, health systems, and other strategic partners.
Build partner-specific operating plans for growth, medical cost, utilization, STARS, RAF, access, and member experience; lead Joint Operating Committees with scorecards, owners, financial expectations, and corrective actions.
Monitor admissions, readmissions, length of stay, emergency department, SNF, outpatient, specialty referral, and pharmacy trends; work with Clinical and UM on avoidable utilization, care transitions, evidence-based management, and appropriate site of care.
Assess delegated, capitated, shared-risk, and fee-for-service performance with Contracting, Finance, and Actuarial; implement recovery plans for high-cost or low-performing partners while preserving medically necessary care and access.
Partner with Finance and Actuarial on forecasts for premium and risk-adjusted revenue, medical expense, administrative cost, and operating contribution.
Quantify opportunities and risks, maintain a pipeline of financial recovery initiatives, lead root-cause analyses and cross-functional recovery plans, and assess return on investment for initiatives.
Provide the Market President with transparent year-end performance projections and deliver predictable performance, early variance detection, and measurable recovery.
Lead local execution through direct reports and matrixed partnerships; develop assigned network, provider engagement, and market performance leaders.
Establish measurable individual objectives tied to market outcomes, succession plans, and performance management; build executive relationships with physicians, hospitals, community stakeholders, and enterprise leaders.
Ensure market initiatives follow CMS, state, contractual, and enterprise requirements.
Provide executive leadership to assigned market management, network management, provider engagement, and performance teams; coordinate internal and external stakeholders across a matrixed organization.
Manage organizational design, workforce and succession planning, leader development, performance management, resource allocation, and business accountability; may oversee third-party vendors and strategic partners within assigned authority.
Travel by car or air as business needs require; evening, weekend, or extended hours may be required.