VP, General Manager (OC)

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 Vice President / Orange County General Manager (VP/OC GM) serves as the senior local business leader responsible for development, execution, operational performance, and financial results of Alignment Health's Medicare Advantage business in Orange County. As day-to-day general manager, this executive converts market strategy into business plans, financial objectives, operational priorities, and disciplined execution.

The role drives five primary value drivers: membership growth and retention; STARS and quality; compliant RAF 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 VP, Market President shares in market strategy for assigned markets, enterprise alignment, and strategic priorities and resource allocation, in collaboration with the Chief of Contracting and Market Management and the company President. The VP/OC GM reports to the VP, Market President and dotted line into the Chief of Contracting is the designated Responsible executive for integrated local market execution under formal RACI governance, working in close collaboration with Sales and other functional leaders. The role operates with the ownership mindset of a local business senior level within approved decision rights.

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 escalate 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 Develop