VP, General Manager

Alignment Health•Tulare, CA

13d•$198,219 - $297,329

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 VP, General Manager serves as the senior leader responsible for driving the operational, financial, and strategic performance of assigned markets within Alignment Health Plan. This role advances Alignment Healthcare’s mission to transform senior care through compassionate service, innovative care models, and strong physician partnerships. The VP, General Manager oversees P&L strategy, market growth, quality performance, and regulatory compliance while optimizing provider networks and ensuring exceptional member experience. This leader builds high impact relationships with providers and community partners, drives 5 Star quality outcomes, and collaborates across the organization to achieve growth, retention, and cost of care goals in a fast growing, mission driven environment.

Requirements

10 years of experience in Medicare Advantage managed care
10 years of experience in contract negotiation strategies, reimbursement methodologies, contract language, financial modeling and analysis
10 years of managerial experience
BA/BS Degree in business or a relevant field is required
Must have strong experience in the Medicare Advantage managed care space, including but not limited to an understanding of CMS payment methodologies, risk adjustment, and Stars.
Must have strong analytical skills and customer service skills.
Must have ability to develop and implement network strategies.
Develop new analyses and approaches to using data that allow fresh insights into the company's business.
Strong experience with provider network management and market performance, with knowledge of the California market strongly preferred.
Strong experience with provider and health plan operations.
Experience with delegated and non-delegated providers.
Understanding of provider contracts for medical groups, independent physicians, ancillary providers and hospitals, including contract language and provider payment methodologies: Hospitals (DRG, per diem), Physicians (RBRVS, FFS, Capitation), value based arrangements and provider incentives.
Excellent knowledge of managed care finance
Excellent interpersonal and relationship management skills
Excellent oral, written and presentation skills and ability to convey complex or technical information in a manner that is readily understood by others.
Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposal.
Excellent Microsoft Office skills, including Word and Excel
30-50% travel by car or air
Available for evenings / weekends and extended work hours as needed

Nice To Haves

MBA strongly preferred.
Strong experience with provider network management and market performance, with knowledge of the California market strongly preferred.

Responsibilities

Develop and execute the P&L strategy for assigned markets, ensuring achievement of financial performance, growth, and medical loss ratio (MLR) targets.
Establish and operationalize predictive KPIs to improve forecasting, performance monitoring, and proactive management of market outcomes.
Drive performance across CAHPS, HEDIS, and HOS measures with the goal of achieving and sustaining 5-Star ratings; ensure effective management of JSAs and AWVs to meet completion targets.
Lead initiatives to improve MRA quality and coding accuracy while ensuring compliance with CMS regulatory requirements and quality program objectives.
Design and execute strategies for optimal provider network development, expansion, and performance in both established and new markets.
Lead the negotiation, implementation, and management of provider contracts, including IPAs/medical groups, hospitals, physicians, ancillary providers, and supplemental vendors.
Develop and implement innovative contracting strategies and reimbursement models, including capitation, case rates, per diems, and value-based arrangements that improve quality and cost efficiency.
Monitor market performance metrics and implement corrective actions to improve utilization, unit cost, quality outcomes, and operational effectiveness.
Build and maintain strong relationships with key stakeholders, including physician leaders, provider organizations, hospitals, and community partners to advance market strategy and performance.
Partner with cross-functional leadership to achieve growth, retention, financial, operational, and quality objectives while ensuring compliance with regulatory requirement.
Oversees assigned staff.
Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.