VP, Community Inclusion & Partnerships; Remote

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, Payment Integrity serves as the senior executive accountable for Alignment Health's enterprise Payment Integrity function and its contribution to payment accuracy, affordability, and medical cost performance. This leader will develop and lead execution of the Payment Integrity strategy, build and scale a high-performing organization, and establish the optimal mix of internal capabilities, technology, and strategic vendor partnerships across prepay and postpay programs.

• Develop, recommend, and lead execution of the multi-year Payment Integrity strategy and capability roadmap, establishing the priorities, investments, operating model, and performance expectations required to advance enterprise medical cost, affordability, and payment accuracy objectives.
• Own delivery of the approved Payment Integrity financial plan and validated savings commitments; recommend annual targets, investment requirements, opportunity priorities, and corrective actions in partnership with Finance and Medical Economics.
• Set the strategic direction for evolving Payment Integrity from retrospective recovery toward prospective prevention, establishing enterprise priorities that improve first-pass payment accuracy, reduce avoidable medical cost, and minimize administrative burden for Alignment and its providers.
• Establish and govern the enterprise Payment Integrity operating model, decision rights, policies, and control framework, including standards for concept approval, savings validation, provider impact, and program performance.
• Establish the executive performance framework for Payment Integrity, ensuring transparent measurement of validated net savings, financial return, program effectiveness, quality, provider impact, and operational performance and using those insights to drive investment and portfolio decisions.

• Set the strategic direction for the Payment Integrity delivery model, determining and recommending the optimal mix of internal capabilities, technology, and external partnerships based on financial return, strategic control, scalability, quality, and provider impact.
• Lead the Payment Integrity sourcing and commercial strategy, including evaluation and negotiation of strategic solutions and partnerships, and recommend material vendor selections and contractual commitments in accordance with enterprise financial and approval authorities.
• Establish the governance, performance standards, economic expectations, and escalation framework for the Payment Integrity vendor portfolio, holding internal leaders and strategic partners accountable for validated net value, quality, compliance, service performance, and provider impact.
• Drive portfolio optimization across internal and external Payment Integrity capabilities, eliminating redundant investment, conflicting concepts, and unnecessary provider abrasion while maximizing enterprise value and strategic alignment.

• Provide executive oversight of the enterprise prepayment integrity portfolio, ensuring clinical, coding, reimbursement, high-dollar, and complex-claim capabilities are prioritized and governed according to financial value, accuracy, scalability, compliance, and provider impact.
• Set the strategy, investment priorities, and performance expectations for postpayment audit and recovery capabilities, with accountability for validated financial yield, timeliness, defensibility, and conversion of retrospective findings into sustainable preventive controls.
• Provide strategic oversight of Coordination of Benefits and Subrogation capabilities, ensuring these programs are integrated into the broader Payment Integrity portfolio and deliver approved recovery, avoidance, compliance, and member/provider…