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

Asks for

The ad says“• Clinical and Operational Data Analysis (Advanced): Ability to interpret complex clinical, financial, and quality performance data; identify root causes of performance variation; and translate findings into action-able, provider-facing improvement strategies.”
The ad says“• Minimum 5 years of clinical practice experience”
The ad says“• Communication and Executive Presentation (Advanced): Excellent written, verbal, and presentation skills — with the ability to communicate complex clinical and financial findings clearly to diverse audiences including providers, market leadership, and executive stakeholders.”
The ad says“• Minimum 3–5 years of leadership experience within managed care, Medicare Advantage, physician organizations, IPA/MSO, or value-based care environments”
The ad says“• Minimum 3–5 years of leadership experience within managed care, Medicare Advantage, physician organizations, IPA/MSO, or value-based care environments”
The ad says“• Utilization Management and Medical Expense Analysis (Advanced): Working knowledge of inpatient/outpatient utilization trends, site-of-service optimization, readmission drivers, and medical expense management — and the ability to lead corrective action planning in response to adverse trends.”
The ad says“• Medicare Advantage and Managed Care Operations (Advanced): Comprehensive knowledge of Medi-care Advantage operations, utilization management, risk adjustment, Stars, HEDIS, and value-based care performance metrics — with the ability to apply this knowledge to market-level provider engagement and performance improvement.”
The ad says“• Provider Engagement and Relationship Management (Advanced): Demonstrated experience working collaboratively with physicians, provider groups, and executive stakeholders to influence performance, drive operational change, and build sustainable clinical partnerships.”
The ad says“• Quality and Stars Improvement (Advanced): Knowledge of HEDIS, CAHPS, HOS, and Stars program requirements — and proven ability to translate quality performance data into targeted, market-level provider engagement strategies that close gaps and improve scores.”
The ad says“• Utilization Management and Medical Expense Analysis (Advanced): Working knowledge of inpatient/outpatient utilization trends, site-of-service optimization, readmission drivers, and medical expense management — and the ability to lead corrective action planning in response to adverse trends.”

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 & Physician Leadership

• Maintain knowledge of Medicare Advantage, CMS, and applicable regulatory requirements impacting provider performance, quality, medical management, and population health.

• Serve as a visible physician leader within the market, fostering strong provider relationships and supporting Alignment's value-based care strategy.

Other duties as assigned

Supervisory Responsibilities:

This role is an individual contributor. The Regional Medical Director exercises clinical influence and market leader-ship through expertise, provider relationships, and cross-functional collaboration — without formal people man-agement authority.

Job Requirements:

Experience:

Required:

• Minimum 5 years of clinical practice experience

• Minimum 3–5 years of leadership experience within managed care, Medicare Advantage, physician organizations, IPA/MSO, or value-based care environments

Preferred:

• Experience supporting delegated provider groups, IPAs, ACOs, or risk-bearing entities

• Experience in value-based contracting and provider performance optimization

• Prior leadership experience supporting Medicare Stars improvement initiatives

• Familiarity with clinical analytics, utilization trending, and provider scorecard methodologies

Education:

Required:

• MD or DO degree from an accredited institution

• Board certification in an ABMS or AOA-recognized specialty

• Active, unrestricted medical license in CA

Preferred:

• Board certification in Family Medicine or Internal Medicine

Training:

Required:

• Demonstrated working knowledge of Medicare Advantage operations, managed care principles, and CMS regulatory requirements applicable to utilization management, quality, and population health

Preferred:

• Formal training in quality improvement methodologies, population health management, or managed care operations

• Familiarity with HEDIS, Stars, risk adjustment, and value-based care performance frameworks

Specialized Skills:

Required:

• Medicare Advantage and Managed Care Operations (Advanced): Comprehensive knowledge of Medi-care Advantage operations, utilization management, risk adjustment, Stars, HEDIS, and value-based care performance metrics — with the ability to apply this knowledge to market-level provider engagement and performance improvement.

• Clinical and Operational Data Analysis (Advanced): Ability to interpret complex clinical, financial, and quality performance data; identify root causes of performance variation; and translate findings into action-able, provider-facing improvement strategies.

• Provider Engagement and Relationship Management (Advanced): Demonstrated experience working collaboratively with physicians, provider groups, and executive stakeholders to influence performance, drive operational change, and build sustainable clinical partnerships.

• Utilization Management and Medical Expense Analysis (Advanced): Working knowledge of inpatient/outpatient utilization trends, site-of-service optimization, readmission drivers, and medical expense management — and the ability to lead corrective action planning in response to adverse trends.

• Quality and Stars Improvement (Advanced): Knowledge of HEDIS, CAHPS, HOS, and Stars program requirements — and proven ability to translate quality performance data into targeted, market-level provider engagement strategies that close gaps and improve scores.

• Communication and Executive Presentation (Advanced): Excellent written, verbal, and presentation skills — with the ability to communicate complex clinical and financial findings clearly to diverse audiences including providers, market leadership, and executive stakeholders.

• Cross-Functional Collaboration (Advanced): Proven ability to operate effectively in matrixed environments — partnering across utilization management, care management, quality, risk adjustment, analytics, and operational teams to drive aligned execution.

Licensure:

Required:

• Active, unrestricted MD or DO medical license in CA

• Board certification in an ABMS or AOA-recognized specialty

Preferred:

• Board certification in Family Medicine or Internal Medicine

Work / Travel

• This is a hybrid position requiring a combination of remote work, onsite provider engagement, and periodic in-person collaboration. The Regional Medical Director is expected to maintain a visible presence within their assigned local market(s) and regularly engage with provider groups, health systems, and internal operational partners.

• Routine travel throughout the local market(s) is required to support provider meetings, performance reviews, operational initiatives, and relationship management activities. Occasional travel to the corporate office and other organizational meetings or events will also be required.

• This role requires the ability to effectively operate both independently and collaboratively across geographically dispersed teams while maintaining strong local market engagement and accountability.

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: $262,145.00 - $393,217.00

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.