Sr. Director, Care Delivery Org, Value Based Care Contracting

Alignment Healthcare USA, LLC in; Orange (CA); On-site; USD 150,000 - 225,000; Full time

Job summary

Alignment Health is recruiting for a senior role to lead value-based contracting, design of alternative payment models, and negotiation with IPAs, large physician groups, and health systems. You will manage the full cycle from planning to loading, coordinating with MSO Contracting and Market Leaders.

You will guide analytics of medical claims data, oversee contract performance, and align strategies with cost and quality goals. A deep background in Medicare Advantage value-based care is expected.

Qualifications

• Minimum 10 years of value-based contract negotiation in managed care or healthcare services.
• Experience negotiating with IPAs, large provider groups, and health systems.
• Strong skills in financial modeling and provider contract design.

Responsibilities

• Lead value-based contracting strategy and execution with cross-functional partners.
• Negotiate complex contracts including IPAs, health systems, and large groups.
• Oversee contract performance and value-based planning with MSO targets.
• Analyze medical claims data and model risk-based scenarios for contracts.
• Build and develop the contracting team with coaching and guidance.
• Coordinate cross-functional support across HEDIS, Credentialing, and Member Services.
• Drive complex cross-functional projects from assessment to implementation.

Skills

Value-Based Contract Negotiation

Financial Data Analysis

Alternative Payment Models

CMS Stars Knowledge

Cross-Functional Leadership

Project & Program Leadership

Education

Bachelor's degree in Healthcare Administration, Business, Finance, or related field

MBA or graduate degree (preferred)

Job description

Job Responsibilities

Lead Value-Based Contracting Strategy and Execution. Develop and execute a value-based contracting strategy aligned to the CDO's total cost and quality goals — partnering with Corporate Contracting, Network Development, and Market Leadership to design alternative payment models, identify new contracting initiatives, and negotiate high-value contracts with complex arrangement structures including IPAs, large physician groups, health systems, and other provider entities. Own the full contracting cycle from planning and document creation through negotiation, execution, and submission for loading.

Negotiate and Manage Complex Provider Arrangements. Lead negotiation of the organization's most complex provider contracts — requiring deep understanding of providers' volume and cost structure, cross-functional collaboration to identify critical negotiation levers, and alignment of negotiation strategy with network accessibility, quality, compliance, and financial performance goals. Attend and facilitate external provider meetings and negotiations as required, ensuring all arrangements are structured to achieve MSO targets while building durable, productive provider relationships.

Drive Value-Based Strategic Planning and Contract Performance Oversight. Partner with key stakeholders and internal teams to develop a value-based strategic plan and oversee contract performance with targeted provider groups — ensuring the organization meets objectives across all value-based provider agreements. Assist in the evaluation, formulation, and implementation of network strategic plans to achieve contracting targets and manage medical costs through effective value-based arrangements.

Analyze Medical Claims Data and Financial Performance. Review medical claims data, analyze cost trends, and develop executive summaries that identify opportunities for mitigating medical cost trend. Apply financial modeling capabilities to assess provider performance, model risk-based contract scenarios, and support the business case for contract structures, alternative payment models, and cost improvement initiatives.

Lead and Develop the Contracting Team. Build, lead, and manage a team of contracting professionals — setting clear performance expectations, developing staff capability, and ensuring the team has the tools, data, and guidance needed to execute complex value-based contracts effectively. Model a high standard of contracting discipline, relationship management, and analytical rigor across the team.

Coordinate Cross-Functional Contract Support. Provide assistance and coordination to internal departments — including HEDIS, Credentialing, Grievance & Appeals, SIU, and Member Services — to obtain required information from providers and ensure contract-related data flows accurately across systems and teams. Coordinate provider status information with member services and internal operational partners to ensure contract execution is reflected across the organization.

Lead Complex Cross-Functional Projects and Programs. Lead the work and deliverables of complex, multi-stakeholder contracting projects from assessment through implementation — including projects that span multiple processes, systems, functions, and lines of business. Ensure project milestones are met, stakeholders are aligned, and deliverables are completed on schedule and to standard.

Other duties and projects not listed above

Supervisory Responsibilities

This role carries full people management authority over the MSO Contracting team. Directly supervises contracting staff and is responsible for all supervisory functions including recruiting, onboarding, coaching, performance management, and retention. Supervisory Responsibilities: Fulfill supervisory responsibilities in accordance with organization policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Job Requirements

Experience: Required: Minimum 10 years of related experience in value-based contract negotiation within a managed care, Medicare Advantage, or healthcare services environment — with a demonstrated track record of successfully negotiating value-based contracts with IPAs, large complex provider systems, hospitals, and large physician entities. Expert-level negotiating skills — including demonstrated experience with complex arrangement structures such as full-risk, shared savings, capitation, and alternative payment models. Experience reviewing medical claims data and developing executive summaries that identify opportunities for mitigating medical cost trend. Proven ability to work in a matrixed organization — gaining consensus, sharing information across stakeholder groups, and driving cross-functional alignment. Experience managing the complete contracting cycle from strategy and planning through execution and contract loading.

Preferred: Familiarity with legal terms in the context of provider contracting. Knowledge of CMS Stars and HEDIS technical specifications and measurable percentiles associated with HEDIS measures. Experience with Commercial, Medicare, and Medicaid contracting across multiple lines of business. Strong financial modeling background — including the ability to model risk-based contracts and total cost improvement scenarios. Ability to apply systems thinking when managing multiple provider value-based initiatives simultaneously.

Education: Required: Bachelor's degree in Healthcare Administration, Business, Finance, or a related field; equivalent combination of professional work experience and education will be considered. Preferred: MBA or graduate degree in healthcare administration, business, or health policy.

Training: Required: Demonstrated working knowledge of value-based care models, alternative payment methodologies, and Medicare Advantage contracting frameworks — through applied experience. Preferred: Formal negotiation training or certification Lean, Six Sigma, or equivalent process improvement methodology.

Special Skills

Required: Value-Based Contract Negotiation (Advanced): Expert ability to negotiate complex, high-value provider contracts — including IPAs, health systems, and large physician groups — with deep knowledge of arrangement structures, financial risk mechanics, and negotiation strategy in a Medicare Advantage value-based care environment. Medical Claims and Financial Data Analysis (Advanced): Proficiency in reviewing and interpreting medical claims data, cost trend analysis, and financial performance metrics — and translating findings into executive-level summaries and actionable contract strategies that drive medical cost improvement. Alternative Payment Model Design and Strategy (Advanced): Deep working knowledge of alternative payment models — including full-risk, shared savings, capitation, and quality-linked incentive structures — and the ability to design and negotiate arrangements that align provider incentives with the organization's total cost and quality goals. Network Strategy and Provider Relationship Management (Advanced): Ability to build and sustain productive executive-level relationships with provider partners — including IPAs, health systems, and community physicians — and to translate network strategy into structured, performance-driven contracting arrangements. Cross-Functional Influence and Stakeholder Alignment (Advanced): Proven ability to operate in a matrixed organization — gaining consensus across Corporate Contracting, Network Development, Finance, Market Leadership, and operational partners — and to drive alignment on contracting strategy and execution without relying exclusively on formal authority. CMS Stars and Quality Program Knowledge (Intermediate to Advanced): Working knowledge of CMS Stars, HEDIS technical specifications, and quality measure percentiles — sufficient to incorporate quality performance requirements into contract structures and provider incentive frameworks. Project and Program Leadership (Advanced): Demonstrated ability to lead complex, cross-functional contracting projects from inception through implementation — managing milestones, stakeholder alignment, and deliverable quality across multiple workstreams and lines of business simultaneously.

Preferred: Licensure: (No specific licensure mentioned)

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. 1. 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. 2. 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.

Pay Range

Pay Range: $149,882.00 - $224,823.00 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.

Alignment Health is championing a new path in senior care that empowers members to age well and live their most vibrant lives. Our mission-focused team makes high-quality, low-cost care a reality for members every day. Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. We believe that great work comes from people who are inspired to be their best. We've built a team of people who want to make a difference in the lives of the seniors we serve. Come join the team that is changing health care — one person at a time.