VP, General Manager (OC)

Alignment Healthcare USA, LLC in; Orange (CA); On-site; USD 198,000 - 297,000; Full time

Job summary

Alignment Health seeks an experienced market leader to drive Medicare Advantage strategy, P&L execution, and STARS/QI outcomes in Orange County, CA. You will collaborate with Sales, Product, Network, Contracting, Finance, and Compliance to deliver growth and value for members.

The role demands 12+ years in Medicare Advantage leadership, exceptional communication, and the ability to turn strategy into actionable plans with clear governance.

Qualifications

• Experience in Medicare Advantage operations and market management.
• Proven leadership in P&L execution and strategic planning.
• Ability to turn strategy into measurable plans with governance (RACI).
• Strong executive communication and negotiation skills.
• Knowledge of provider networks, STARs, RAF, and risk adjustment.

Responsibilities

• Lead the Orange County Medicare Advantage market plan and align with enterprise strategy.
• Translate targets into initiatives, owners, milestones, and forecasts.
• Own daily execution of plans for revenue, medical expense, MLR, and growth.
• Develop market plans by provider, geography, product, and member segment.
• Maintain market scorecards and lead reviews; drive recovery plans where needed.
• Establish formal governance for market initiatives and coordinate cross-functional teams.
• Deliver net growth, retention, revenue, and market share targets.

Skills

Strategic leadership

P&L management

Market planning

Cross-functional collaboration

Executive communication

Negotiation

Analytics

Education

Bachelor’s degree or equivalent

MBA, MHA, MPH, JD or related advanced degree

Tools

Microsoft Office

BI tools

Job description

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.

General Duties/Responsibilities

1. Market Business Planning and P&L Execution
   • Lead the annual Orange County Medicare Advantage business plan, aligning market commitments 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 a market scorecard against budget, forecast, prior year, and targets; lead monthly reviews and corrective action.
   • Escalate material financial, regulatory, contractual, and execution risks with recommended recovery plans.
   • Primary performance commitment: Deliver approved financial results and an MLR of 87% or less.
2. RACI Governance and Execution
   • Establish a formal RACI for each Orange County market initiative with one Accountable decision owner, Responsible execution owners, and Consulted/Informed stakeholders.
   • Act as the Responsible executive for 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 clear deliverables.
   • Conduct weekly execution, monthly performance, and quarterly strategic reviews.
   • Hold local and functional leaders to documented commitments; resolve barriers within delegated authority and escalation of unresolved issues.
   • Drive recovery plans rather than serving only as an advisor or meeting participant.
3. Membership Growth, Retention and Market Development
   • Lead local growth and retention execution in collaboration 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; initiate recovery plans where needed.
   • Ensure provider-related marketing and referral initiatives comply with CMS requirements.
   • Primary performance commitment: Deliver approved net growth, retention, revenue, and market share targets.
4. STARS, Quality and Member Outcomes
   • Own local execution of approved STARS and quality plans in partnership with enterprise Quality, Clinical, Pharmacy, Operations, and providers.
   • Build provider-specific objectives for HEDIS, CAHPS, HOS, medication adherence, preventive care, and applicable measures.
   • Coordinate internal clinicians and external provider groups to close care gaps and improve member outcomes.
   • Embed quality scorecards, corrective actions, and compliant incentives in provider operating reviews.
   • Monitor performance by provider, contract, product, and market and address underperformance.
   • Primary performance commitment: Deliver approved STARS and quality objectives through provider and internal execution.
5. Risk Adjustment, RAF and Revenue Integrity
   • Lead local execution with Risk Adjustment, Clinical, Compliance, Finance, and provider teams.
   • Build provider plans for accurate documentation, appropriate diagnosis recapture, and complete encounter submissions.
   • Monitor RAF, coding accuracy, assessment completion, and provider-level variation.
   • Coordinate internal and external clinical resources for timely, clinically appropriate assessments.
   • Address workflow and submission barriers and incorporate compliant RAF results into forecasts.
   • Ensure diagnosis reporting is supported by valid clinical documentation; never incentivize unsupported diagnoses.
   • Primary performance commitment: Achieve approved compliant risk adjustment and revenue integrity goals.
6. Provider, Hospital and Medical Cost Performance
   • 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, average length of stay, ED, 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.
   • Identify high-cost or low-performing partners and implement recovery plans while preserving medically necessary care and access.
   • Primary performance commitment: Improve provider and hospital performance in support of MLR at or below 87%.
7. Financial Management and Performance Recovery
   • 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 in growth, provider economics, utilization, quality, and RAF.
   • Maintain a pipeline of financial recovery initiatives with owners, anticipated impact, and realization dates.
   • Lead root-cause analyses and cross-functional recovery plans for adverse variances.
   • Assess return on investment for provider, growth, and operating initiatives and recommend resource priorities.
   • Provide the Market President with transparent projections of year-end performance.
   • Primary performance commitment: Deliver predictable performance, early variance detection, and measurable recovery.
8. Executive Leadership and Talent Development
   • Lead local execution through direct reports and matrixed functional partnerships.
   • Develop assigned network, provider engagement, and market performance leaders.
   • Establish measurable individual objectives tied to market outcomes, succession plans, and performance management.
   • Build strong executive relationships with physicians, hospitals, community stakeholders, and enterprise leaders.
   • Ensure market initiatives follow CMS, state, contractual, and enterprise requirements.
   • Additional duties as required.

Supervisory Responsibilities

Provides executive leadership to assigned market management, network management, provider engagement, and performance teams. Coordinates internal and external stakeholders across a matrixed organization. Responsibilities include 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.

Job Requirements

Experience Required: Minimum 12 years of progressive leadership in Medicare Advantage, managed care, health plan operations, market management, provider network management, or related fields.

Required: Minimum 7 years leading complex market-level teams and cross-functional initiatives.

Required: Demonstrated responsibility for P&L execution, medical economics, growth, provider performance, and operational outcomes.

Required: Significant Medicare Advantage experience in risk adjustment, STARS, medical cost, delegated arrangements, and value-based care.

Required: Experience building business plans, leading financial reviews, and delivering corrective actions.

Preferred: Market general manager, regional business leader, or equivalent P&L-oriented executive experience.

Education Required: Bachelor’s degree or equivalent combination of education and relevant experience.

Preferred: MBA, MHA, MPH, JD, or related advanced degree.

Specialized Skills Required: Strong general management, financial ownership, forecasting, budgeting, and performance management capabilities.

Required: Expert knowledge of Medicare Advantage economics, STARS, RAF, provider performance, and medical cost.

Required: Ability to turn strategy into plans, RACI governance, measurable outcomes, and sustained execution.

Required: Ability to influence senior executives and matrixed teams without direct reporting authority.

Required: Knowledge of provider contracts, shared risk, hospital economics, and clinical utilization.

Required: Excellent executive communication, negotiation, problem-solving, and analytical skills.

Required: Proficiency in Microsoft Office and business intelligence/analytics tools.

Licensure Required: None.

Other Travel by car or air as business needs require.

Evening, weekend, or extended hours may be required.

Work Environment The work environment characteristics described here are representative of those encountered while performing essential functions. Reasonable accommodations 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 the job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Regularly required to communicate, sit, stand, walk, use hands to handle objects or controls, and reach with hands and arms. Frequently lifts and/or moves up to 10 pounds. Specific vision abilities include close vision and the ability to adjust focus.

Equal Employment Opportunity Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affiantative Action. We seek diversity in qualified candidates for employment, including Minority/Female/Disabled/Protected Veteran candidates. Reasonable accommodations are available in accordance with applicable law.

Pay Range: $198,219.00 - $297,329.00 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.