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.

Reporting to the Chief of Contracting and Market Management, the Vice President/Market President role is a critical leadership position responsible for driving market performance and achieving operational excellence. The primary focus of this role is to meet the market’s key performance indicators and operating targets. The VP/Market President will manage end-to-end market performance, including overseeing P&L performance, market planning, and execution, while fostering effective relationships with key stakeholders across the healthcare ecosystem. To achieve key metrics, the VP/Market President must drive collaboration and hold stakeholders accountable (internal and external). An exceptional understanding of, and demonstrated experience working within the Colorado provider network is required, including familiarity with local market dynamics, key health systems, and market performance. An exceptional understanding of, and demonstrated experience working within the Colorado provider network is required, including familiarity with local market dynamics, key health systems, and market performance.

An exceptional understanding of, and demonstrated experience working within the Colorado provider network is required, including familiarity with local market dynamics, key health systems, and market performance.

Responsibilities:

• P&L Management: Develop and execute the P&L strategy for assigned markets and expansion markets, ensuring financial targets and MLR of 85% are met or exceeded. Develop and operationalize predictive KPIs to better forecast and manage responsible markets.
• Operational Excellence: Drive performance in CAHPS, HEDIS, and HOS measures, aiming for 5 STARs, and ensure efficient management of JSAs and AWVs to achieve 85% completion rates.
• Quality and Compliance: Lead initiatives to improve MRA quality and coding accuracy, maintaining compliance with CMS regulations, and achieving targets for quality programs.
• Stakeholder Engagement: Build and maintain strong relationships with physician leaders, health systems, IPAs, and community partners to enhance market performance and strategic alignment.
• Sales and Membership Growth: Direct local sales teams through market leaders to achieve a minimum of 30% net membership growth annually, aligned with market goals and regulatory requirements with a push with aligned quality partners.
• Performance Management: Conduct business reviews through developed scorecards from provider operations, assess performance metrics, and implement corrective actions to drive improvements across key performance indicators. Work with Health Economics and Contracting teams to analyze contract rate trending impact and anomalies.
• Market Strategy:  Lead in-depth market analysis to identify key trends, competitor landscape, consumer needs and network strategies within the region. Develop business plans to drive the market strategy to support growth and sustainable plan performance.
• Health Plan Oversight: Collaborate with Medical Officers and other departments to manage IPA, medical group, and hospital performance, with a focus on achieving budget and operating goals.
• Utilization and Cost Management: Monitor regional performance, implement standardized performance scorecards, address utilization and cost outliers to enhance overall market efficiency, and promote the use of Alignment Health’s clinical programs.
• Network Management: Analyze, negotiate, and manage contracts with PCPs, specialists, and ancillary providers to optimize network performance and support plan objectives.
• Innovation and Product Development: Partner with product teams to drive innovation, manage the annual bid process, and introduce new initiatives that enhance market competitiveness.
• Medicaid and Dual Eligible Strategy: Develop and launch strategies to drive growth and retention in the dual eligible segment, including Medicare and Medicaid plans.
• Compliance and Governance: Ensure adherence to all health plan compliance requirements in line with CMS regulations, and lead initiatives to improve patient satisfaction and operational compliance.

This role is pivotal in driving market success and delivering value to Alignment Health members by managing financial, operational, and quality performance effectively and sustainably.

Supervisory Responsibilities:

Oversees assigned staff that support the network management needs of the markets. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Required Skills and Experiences:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

Minimum Experience:

At least ten years of experience in financial/data analysis.

At least ten years of managerial experience

Education/Licensure:

BA/BS Degree in business or a relevant field is required; an MBA is preferred.

Other:

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 Arizona 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

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

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.

Alignment Health is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

Pay Range: $227,952.00 - $341,928.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.