VP, General Manager (OC)

Alignment Healthcare•Orange, CA

About The Position

The Vice President / Orange County General Manager is the senior local business leader responsible for the development, execution, operational performance, and financial results of Alignment Health’s Medicare Advantage business in Orange County. The role translates market strategy into business plans, financial objectives, operational priorities, and disciplined execution, with responsibility for membership growth and retention; STARS and quality; compliant risk adjustment and revenue integrity; provider and hospital performance; and market profitability, including a medical loss ratio (MLR) target of 87% or less, subject to quality, access, and regulatory requirements. The position shares in market strategy, enterprise alignment, strategic priorities, and resource allocation in collaboration with the VP, Market President, the Chief of Contracting and Market Management, and the company President. It is the designated Responsible executive for integrated local market execution under formal RACI governance and works closely with Sales and other functional leaders. The role operates with local senior-business-leader ownership within approved decision rights and reports to the VP, Market President, with a dotted-line reporting relationship to the Chief of Contracting. The executive leads local execution through direct reports and matrixed functional partnerships, including market management, network management, provider engagement, and performance teams. Responsibilities include organizational design, workforce and succession planning, leader development, performance management, resource allocation, and business accountability. The role may oversee third-party vendors and strategic partners within assigned authority. Travel by car or air may be required based on business needs; evening, weekend, or extended hours may also be required.

Requirements

Minimum 12 years of progressive leadership in Medicare Advantage, managed care, health plan operations, market management, provider network management, or related fields.
Minimum 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.
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.
Bachelor’s degree or equivalent combination of education and relevant experience.
Licensure is not 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 major provider, hospital, geography, product, and membership segment; maintain market scorecards and lead monthly performance reviews and corrective actions.
Escalate material financial, regulatory, contractual, and execution risks with recommended recovery plans.
Establish formal RACI governance for market initiatives and coordinate integrated execution across Sales, Product, Network, Contracting, Finance, Actuarial, Clinical, Quality, Risk Adjustment, Pharmacy, Operations, Member Experience, and Compliance.
Maintain initiative roadmaps, conduct weekly execution, monthly performance, and quarterly strategic reviews, hold leaders to documented commitments, resolve barriers, and drive recovery plans.
Lead local membership growth and retention with Sales, Product, Marketing, Broker Distribution, and provider leadership; set 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 Quality, Clinical, Pharmacy, Operations, and provider teams.
Set provider-specific objectives for HEDIS, CAHPS, HOS, medication adherence, preventive care, and applicable measures; coordinate care-gap closure and monitor performance by provider, contract, product, and market.
Embed quality scorecards, corrective actions, and compliant incentives in provider operating reviews 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 and lead Joint Operating Committees with scorecards, owners, financial expectations, and corrective actions.
Monitor utilization and cost trends, including admissions, readmissions, average length of stay, emergency department, skilled nursing facility, outpatient, specialty referral, and pharmacy; 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 market 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; assess return on investment and recommend resource priorities.
Provide the Market President with transparent year-end performance projections and deliver predictable performance, early variance detection, and measurable recovery.
Lead and develop assigned network, provider engagement, and market performance leaders; set measurable objectives tied to market outcomes, succession plans, and performance management.
Build executive relationships with physicians, hospitals, community stakeholders, and enterprise leaders, and ensure market initiatives comply with CMS, state, contractual, and enterprise requirements.
Perform additional duties as required.
Travel by car or air as business needs require; evening, weekend, or extended hours may be required.