Hybrid Remote Regional Medical Director, Health Plan (Must reside in Orange County California) at Alignment Healthcare

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. The Hybrid Remote Regional Medical Director is a market-facing physician leader responsible for improving clinical, quality, utilization, risk adjustment, and financial performance across assigned provider networks and geographic markets. This role partners closely with Network Management, Quality, Risk Adjustment, Pharmacy, Clinical Operations, and providers, provider groups, and health systems to create and execute strategies that improve MLR, Stars performance, member outcomes, and value-based care results. The Regional Medical Director serves as a trusted advisor to providers and health systems, leveraging data-driven insights, clinical expertise, and strong provider relationships to drive accountability, performance improvement, and long-term market success. ***Must reside in Orange County California*** Job Responsibilities: Market & Provider Performance Leadership • Serve as the physician leader supporting performance across assigned markets and provider networks. • Maintain a deep understanding of local provider landscapes, referral patterns, market dynamics, and local operational challenges impacting performance within their region. • Build collaborative relationships with providers to promote alignment around managed care principles, population health strategies, quality improvement initiatives, and value-based care performance. • Partner with Network Management and network providers to improve quality, affordability, risk adjustment, Stars, member experience, and overall value-based care performance. • Lead provider-facing discussions, performance reviews, and action planning efforts to drive accountability and measurable outcomes. • Act as a trusted clinical advisor to provider groups, IPAs, health systems, and internal stakeholders. Value-Based Care & Clinical Performance Improvement • Analyze clinical, operational, financial, utilization, and quality data to identify performance gaps and improvement opportunities. • Develop and support market-specific strategies that improve MLR, utilization, quality outcomes, care coordination, and population health performance. • Collaborate with providers and provider organizations to implement evidence-based interventions that improve efficiency, consistency of care, and member outcomes. • Monitor performance against established goals and adjust strategies as needed to achieve sustainable results. Risk Adjustment, Quality, & Population Health • Partner with provider organizations and internal teams to improve documentation accuracy, risk adjustment performance, chronic disease management, and preventive care outcomes. • Support provider engagement efforts focused on improving Stars, HEDIS, CAHPS, HOS, medication adherence, and care gap closure. • Promote population health strategies that improve member outcomes while supporting organizational objectives. Cross-Functional Collaboration & Strategic Initiatives • Collaborate with Network Management, Risk Adjustment, Quality, Pharmacy, Care Management, Utilization Management, Analytics, and Operations teams to align improvement strategies and execution efforts. • Support value-based care initiatives, provider performance programs, and other enterprise priorities. • Participate in market, provider, and organizational committees, workgroups, and strategic initiatives as assigned. Regulatory & Physic