Alignment Health

• Implementing, maintaining, and optimizing Workday Human Capital Management (HCM) functionalities. • Working closely with HRIS Product Owners and responsible for Workday configuration, analytics, reports, integrations, and security. • Collaborating with HRIS organization, External Application Managed Services, IT, HR, Payroll, and Finance to understand business processes and compliance requirements, evaluate system impacts, and deliver scalable Workday solutions that align with business objectives and support long-term system sustainability. • Resolving enhancement requests from monthly release and enhancement cycles across Workday HCM modules, partnering with HRIS Product Owners and business stakeholders to design, document, test, and deploy scalable solutions. • Participating actively in Workday HCM enhancement initiatives, system upgrades, and support projects, serving as a functional and technical subject matter expert. • Configuring and maintaining Workday functionality including business processes, reports, integrations, calculated fields, and analytics while ensuring solutions are designed for long-term scalability and maintainability. • Reviewing business requirements with stakeholders, recommending appropriate system solutions, and configuring and deploying enhancements aligned with business objectives and Workday best practices. • Maintaining detailed system documentation in accordance with SOX and SDLC requirements established by Alignment Healthcare. • Managing and resolving HRIS support cases within established service level agreements (SLAs), ensuring timely resolution and clear communication with stakeholders. • Developing and maintaining user guides, job aids, and process documentation with a focus on improving the employee and manager user experience. • Supporting internal and external audits by providing system documentation, data validation, and evidence of controls and compliance processes.

• Conduct in-home assessments on Alignment members, medication review and health screenings • Provide patient education by matching care desired with best care given • Identify diagnoses to be assessed in care management and active medical management • Partner and communicate with Regional Medical Officer and other team members to discuss and develop the most appropriate care plans possible based on the needs of our members/patients. • Coordinate care with multiple stakeholders, including but not limited to PCPs, specialists, and ancillary providers. • Lead broader clinical team which may include nurses, health coaches, social workers, and care coordinators

• Lead enterprise strategic sourcing and supplier delivery activities • Responsible for leading all enterprise sourcing and sourcing of goods and services • Partner with spend owners to maximize the value from suppliers • Work with functional business partners and Finance from initial need identification to final goods and services delivery • Lead efforts in demand management, supply chain strategy, supplier identification, sourcing selection, contract negotiations • Manage supplier onboarding/offboarding and performance management

Role Description The Senior Technical Product Manager will lead product strategy, roadmap, and execution for Alignment’s Utilization Management (UM) capabilities and functions. This role will translate complex operational and clinical business needs into innovative technical solutions that improve efficiency, decision quality, provider experience, and member outcomes. - Own end-to-end product strategy for UM and key AVA platform domains and guide multi-year roadmaps that integrate business, operational, and strategic priorities. - Partner with Operations, Transformation, and Clinical teams to redesign workflows that improve clinical outcomes, reduce administrative burden, and enable providers to operate at the top of their license. - Drive AI-enabled automation opportunities across intake, clinical review, authorization decision support, workflow routing, and operational reporting. - Drive AVA platform evolution and ensure strategic alignment across key business domains (e.g., clinical, consumer, finance, Stars, risk). - Mentor product managers and demonstrate best practices, elevating product thinking, execution quality, and cross-team collaboration. - Drive strategy and roadmap for next-generation operations, clinical, and care coordination apps. - Conduct product portfolio opportunity assessments, identifying product gaps and new opportunities to grow market share and enhance experience. Qualifications - 7-10+ years in healthcare product management with demonstrated success leading large-scale products. - Experience with agile product delivery and quantitative usage/product analytics & optimization. - Experience designing or scaling enterprise AI/ML products (preferred). - Proven experience shaping organizational product practices, including OKR development, partnership & landscape assessment, and roadmap governance (preferred). - Bachelor’s degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field (required). - MBA or advanced degree (preferred). Requirements - Expertise across multiple health domains (e.g., Stars, clinical operations, care coordination, plan operations, claims, consumer health, or risk adjustment). - Strong technical depth in data platforms, API-driven products, solution architecture, and enterprise systems. - Proven ability to lead through ambiguity, influence without authority, and drive change across matrixed organizations. - Excellent communications skills with ability to articulate strategy and decision frameworks to executive audiences. - Strong process improvement expertise (Lean, Six Sigma) (preferred). Benefits - Pay Range: $130,332.00 - $195,498.00 - Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Essential Physical Functions - 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. - 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.

• Develop and own the member marketing and communications strategy and plan for assigned programs • Identify and define the member data and insights needed to inform campaign strategy • Author all member-facing and campaign-supporting communications across formats and channels • Develop and manage integrated multi-channel programs spanning direct mail, email, SMS, IVR, and digital • Define success metrics before execution begins and analyze marketing campaign performance across channels and audiences • Build and maintain strong working relationships with Stars, Pharmacy, Clinical, Member Experience, Network, and Market Leadership teams

• Develop and execute comprehensive product strategies for technical products and services • Oversee the entire product lifecycle from ideation to development, launch, and ongoing optimization • Define product requirements, specifications, and roadmaps in collaboration with engineering teams • Ensure products meet market needs, are developed within budget and on schedule • Bridge the gap between technical teams and business stakeholders through clear communication • Translate complex technical concepts into business value propositions • Work closely with engineering teams using Agile methodologies and development processes • Evaluate technical feasibility and make data-driven product decisions • Collaborate with engineering, design, operations, compliance, and vendor teams • Lead product planning sessions and sprint reviews • Facilitate communication between technical and non-technical stakeholders • Coordinate product launches and go-to-market strategies • Conduct market research and competitive analysis to inform product decisions • Gather and analyze customer feedback to drive product improvements • Define and track key performance indicators (KPIs) for product success • Ensure products solve real customer problems and deliver business value

• Responsible for reviewing requests for appeals of both inpatient and outpatient services for all plan members • Collaborates closely with providers, Regional and Senior Medical Directors and Utilization Management for timely processing of appeals • Reviews and prepares appeal requests for medical necessity and refers to Medical Director any appeal that requires MD approval or denial • Independently applies evidence-based clinical criteria to conduct objective medical necessity reviews and make appeal determination recommendations • Maintain goals for established turn-around time (TAT) for appeal processing • Coordinate peer-to-peer conversations to maintain professional rapport with providers and patients • Verify eligibility and/or benefit coverage for requested services • Verify accuracy of ICD 10 and CPT coding in processing appeal requests • Review appeal denials for appropriate guidelines and language and prepare denial letters as appropriate

Role Description Alignment Health is seeking a compassionate, customer service oriented, and organized Care Coordinator (bilingual Spanish highly preferred) to join the remote outpatient case management team. The Remote Care Coordinator works alongside the RN case manager and interdisciplinary care team to support members with complex and chronic health needs. In this role, you will help coordinate services, close care gaps, and ensure members receive timely, appropriate care. You’ll play an important role in supporting members enrolled in case management by assisting with care coordination activities, scheduling and service coordination, and helping members navigate their care plan and available resources. Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time Location: Fully Remote General Duties / Responsibilities: - Reach out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc. - Create cases, tasks, and complete documentation in the case management module for all hospital and skilled nursing facility (SNF) discharges. - Comply and document tasks assigned by nurse. - Work as a team, in this fully remote role, with the case manager to engage and manage a panel of members. - Manage new alerts and update case manager on changes in condition, admission, discharge, or new diagnosis. - Establish relationships with members, earn their trust and act as patient advocate. - Escalate concerns to nurse if members appear to be non-compliant or there appears to be a change in condition. - Assist with outreach activities to members in all levels of case management programs. - Assist with maintaining and updating members' records. - Assist with mailing or faxing correspondence to members, primary care physicians (PCP), and/or Specialists. - Request and upload medical records from PCP’s, specialists, hospitals, etc. - Meet specific deadlines (respond to various workloads by assigning task priorities according to department policies, standards, and needs). - Maintain confidentiality of information between and among health care professionals. - Other duties as assigned by case manager (CM) supervisor, manager or director of care management. Qualifications - Minimum (1) year experience working in health care such as health plan, medical office, Independent Practice Association (IPA), Management Services Organization. - Minimum (1) year experience assisting members/patients with authorizations, scheduling appointments, identification of resources, etc. - High School Diploma or GED required; Bachelor's degree or four years additional experience in lieu of education preferred. - Bilingual English and Spanish preferred. Requirements - Able to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. - Able to write routine reports and correspondence. - Communicate effectively using customer relations skills. - Able to communicate positively, professionally, and effectively with others; provide leadership, teach, and collaborate with others. - Effective problem solving, organizational and time management skills; able to work in a fast-paced environment. - Knowledge of Managed Care Plans and Medi-Cal. - Basic computer proficiency, type a minimum of 35 words per minute (WPM), proficient in Microsoft Office suite (Outlook, Excel, Word). - Able to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. - Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Benefits - Pay Range: $41,472.00 - $62,208.00. - Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

• Supports our members in their disenrollment requests and related quality assurance. • Acts in a customer-focused manner and is genuinely interested in the needs of our members. • Address’ various customer-related needs and problem-solve to effectively resolve call escalations. • Serves as a “subject matter expert” in escalated member calls at risk of disenrollment. • Identifies process improvement opportunities within the Member Engagement department. • Responsible for meeting and exceeding monthly goals as assigned. • Conducts outbound phone calls and/or receiving inbound phone calls within the department’s goal timeframe. • Collaborates with our partners to facilitate the member experience. • Participates in required team meetings and trainings.

• Take full ownership of complex, urgent, and high-visibility member escalations • Lead service recovery efforts with a focus on empathy and active listening • Serve as the primary point of contact for sensitive or escalated issues • Monitor active cases to ensure adherence to SLAs and quality standards • Collaborate closely with the Supervisor, Customer Success to ensure alignment