Alignment Health Plan Jobs in Usa

Join the team leading the next evolution of virtual care.

At Teladoc Health, you are empowered to bring your true self to work while helping millions of people live their healthiest lives.

Here you will be part of a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth. Together, we're transforming how better health happens.

Summary of Position

Under the general direction of the Health Plan Management leadership, the Health Plan Management Associate will work closely with the Health Plan team to support key initiatives for a select group of Health Plan clients that result in exceptional service and attentiveness to client needs.

The Health Plan Management Associate must be a reliable selfstarter who thrives in a fastpaced, challenging environment, maintains a positive attitude, and demonstrates strong attention to detail and multitasking abilities.

Essential Duties and Responsibilities

• Acts in a support role for a book of business within the HP management team supporting Health Plan Managers with their accounts.
• Internal and external coordination, tracking of requests, and driving resolution of issues across various internal and external teams, building strong relationships along the way.
• Performance Guarantee and Service Level Agreement Tracking
• Tracking & submission of security audit/inquiries.
• Provide regular status reporting to track project/tasks progress against goals, objectives, and timelines.
• Develop and own a project management tracking system that enables efficient monitoring of key tasks and ensures consistent followthrough.
• Maintaining Health Plan Partner playbook.
• Coordinating and monitoring Marketing activities, triaging issues as required.
• Other requests to support the overall Health Plan book of business.

The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs.

Supervisory Responsibilities

No

Required Qualifications

• A Bachelor's degree from a four-year college or university.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint) and Outlook.
• Possesses excellent communication and presentation skills, both verbal and written.
• Must work collaboratively with all team members and cross-departmentally.
• Occasional travel may be required for internal and client facing meetings.

As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home. 

It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

Showing Up Somatus Strong

We foster an inclusive work environment that promotes collaboration and innovation at every level. Our values bring our mission to life and serve as the DNA for every decision we make:

• Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.
• Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.
• Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests.
• Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions. 
• Tenacity: We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners.

Showing Up for You

We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including:

• Subsidized, personal healthcare coverage (medical, dental vision)
• Flexible PTO
• Professional Development, CEU, and Tuition Reimbursement
• Curated Wellness Benefits supporting teammates physical and mental well-being
• Community engagement opportunities
• And more!

As a Vice President of Business Development, you will drive new logo growth and sales pipeline development while playing a key role in the continued growth of the company. You will support strategic initiatives working with health plans, employer groups, ACOs, hospitals and health systems, provider groups, and other healthcare organizations.  

• Build, own, and maintain a robust pipeline of qualified opportunities by cultivating executive-level relationships with payors, ACOs, Health Systems, and other strategic partners 

• Work closely with company leadership to lead and coordinate complex deal execution and strategy in a fast-paced, competitive, and entrepreneurial environment 

• Deliver measurable revenue and membership growth by rapidly advancing opportunities through all stages of the sales pipeline to contract execution 

• Represent the company at industry events and client meetings to promote thought leadership, and drive new business opportunities 

• Develop effective outbound content and thought leadership in partnership with the marketing team 

• Stay up to date on knowledge of industry trends, market intelligence, and state/federal regulations and programs 

• Lead proposal writing efforts to demonstrate company capabilities and secure new business opportunities 

• Provide real-time pipeline and relationship updates, forecast accuracy, and growth reporting to executive leadership with a focus on transparency, urgency, and outcomes 

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

• 7-10 years of relevant experience in business development, enterprise sales, consulting, or commercial role working with health plans, provider groups, or other healthcare organizations 

• Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization, including executive and C-level 

• Commercial acumen and a proven track record of driving new business development and creatively structuring agreements 

• Ability to connect with diverse constituents and stakeholders across cross-functional teams (leadership, marketing, account management, new product development, data and analytics, market operations, finance and clinical) 

• Demonstrated success driving new revenue growth and closing favorable deals with national and regional payors, ACOs, and other risk-bearing entities 

• Experience developing compelling presentations using Microsoft PowerPoint 

• Salesforce experience  

• Travel to HQ in McLean, Virginia and client locations 

Health Plan IT Director

Onsite | Dallas, Texas

We are seeking an experienced IT Applications Manager to lead health plan-focused application development and support within our payer organization in Dallas, TX.

This role oversees mission-critical insurance systems supporting eligibility, utilization management, care management, pharmacy, and related payer operations. This is not a hospital IT role — we are seeking a leader with direct health plan / insurance-side experience. The ideal candidate brings strong payer application knowledge, a data-driven mindset, and proven success leading teams in delivering projects on time and within scope.

What You’ll Do

• Lead and manage a team of IT professionals supporting health plan applications
• Oversee application development, integration, enhancement, and production support
• Partner closely with business stakeholders to translate operational needs into technical solutions
• Provide architectural input and solution design guidance (non-coding leadership role)
• Manage vendor relationships, including third-party system implementations (e.g., pharmacy platforms)
• Ensure strong process control, documentation, and system governance
• Drive project execution with strong focus on timelines, accountability, and quality
• Collaborate with enterprise IT teams to ensure cohesive system integration
• Maintain compliance with HIPAA and healthcare data privacy standards

What We’re Looking For

• 5+ years of IT leadership experience within a health plan / payer organization
• Direct experience supporting insurance-side systems (eligibility, UM, care management, pharmacy)
• Strong background in data-driven application environments
• Experience overseeing vendor implementations and system integrations
• Demonstrated ability to lead cross-functional projects and meet deadlines
• Strong documentation, process management, and operational discipline
• Experience managing teams of 10+ FTEs
• Working knowledge of SQL and application environments (technical fluency required; coding not required)
• Bachelor’s degree in Computer Science or related field

Summary:

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
• Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
• Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
• Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
• Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
• Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines.
• Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
• Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
• Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
• Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate. 
• Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
• Must be able to take after hour calls to meet business requirements as needed.

Job Requirements:

Education/Skills

• Graduate of an accredited school of vocational nursing or equivalent required
• Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred

Experience

• 3 – 5 years of nursing experience preferred
• Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
• General computer knowledge and capability to use computers required

Licenses, Registrations, or Certifications

• LVN license in the state of employment or compact required
• RN license in state of employment or compact preferred

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

About us:

At Cedar Creek, we treat a wide range of mental health conditions using evidence-based approaches that are tailored to the unique needs of each individual and delivered with care and compassion. We provide residential mental health treatment for adults (18+) of all genders in a safe and compassionate environment. Our experienced clinical team specializes in complex cases, delivering evidence-based care tailored to each individual. We create a supportive setting that fosters healing and long-term recovery. As part of our commitment to whole-person care, our Family Support Program offers multiple opportunities for family therapy to assist loved ones throughout the treatment journey.

What We Offer

• Collaborative environment dedicated to clinical excellence
• Multiple Career Development Pathways
• Company Supported Continuing Education & Certification
• Multiple Health Plan Design Options Available
• Flexible Dental & Vision Plan Options
• 100% Company Paid EAP Emotional Well-Being Support
• 100% Company Paid Critical Illness (with health enrollment plan)
• 100% Company Paid Life & ADD
• 401K with Company Match
• Company-Sponsored HSA, FSA, & DSA Tax Savings Accounts
• Generous Team Member Referral Program
• Parental Leave

Position Summary

STR Behavioral Health Cedar Creek provides evidence based, clinically excellent, client-centered care for individuals seeking treatment for Mental health along a full continuum of care designed to support long-term sustainable care. The CEO influences and communicates the strategic vision and objectives within the facility and is responsible for creating a positive culture committed to superior client care. The facility CEO directs day-to-day operations, ensures clients are provided with robust clinical programming in a safe and comfortable therapeutic environment, manages and develops staff, ensures sound fiscal operations and promotes positive relationships with clinical partners, referents, payors, and the community.

Relationships and Contacts

Within the organization: Reporting to the Group CEO, the facility CEO provides leadership to all staff located at STR Cedar Creek and works collaboratively with network support team members and the governing body.

Outside the organization: Builds and maintains strong professional relationships with clinical and healthcare providers, community partners, vendors, and clients/families.

Essential Responsibilities

1. Collaborates with the governing body to develop and implement clinical programs and operational objectives that promote program growth and respond to changes in the market.

2. Creates and sustains a culture and environment that is focused on providing clinically excellent, client centered care in alignment with the treatment philosophy and core values.

3. Ensures achievement of business objectives through day-to-day operational, financial, clinical, and regulatory oversite of all programs.

4. Effectively manages resources to meet the needs of clients while maximizing resources and minimizing waste.

5. Ensures the timely submission of operational reviews and key performance metrics; interpreting metrics and proactively adapting operations as needed.

6. Promotes the professional growth and development of staff throughout all levels of the facility, championing effective teamwork and critical thinking.

7. Ensures compliance with all licensures, accreditations, contracts, state, and federal laws.

8. Supports the development, implementation, and enforcement of all policies and procedures, including patient rights.

9. Monitors and continuously improves program quality through research and application of industry best practices.

10. Establishes a welcoming environment and strong culture of customer service throughout the facility.

11. Promotes systems of communication and collaboration between admissions, business development, utilization review, finance, and clinical teams.

12. Supports the admissions process by reviewing and approving admissions ensuring the admissions process is smooth, efficient, and client focused.

13. Leads and promotes active communication with department leaders around all actual or potential problems or issues that could result in risk exposure or client dissatisfaction.

14. Provides regular supervision for staff discussing challenges, successes, enhance effectiveness and efficiency of procedures and operation of the program.

15. Collaborates with leadership to ensure proper interpretation and fulfillment of position functions, responsibilities, authority, and relationships.

16. Balances team and individual responsibilities; exhibits an openness to others’ views; gives and welcomes feedback; puts team success over own interests.

17. Manages difficult or emotional client situations, responds promptly to client needs, solicits client feedback to improve service; responds to requests and meets commitments.

18. Communicates clearly and concisely with clients, families, all members of the interdisciplinary team and referral partners.

Additional Responsibilities

1. Maintains effective relationships with organizations in the local community and throughout the behavioral health field.

2. Periodically provides presentations regarding program services and participates in tours, as needed.

3. Acts as leadership on-call designee for emergencies or assigns on call designee when personally unavailable.

4. Ensures follow up with referral sources following admissions, discharges, and during treatment process.

5. Assists with conferences and marketing activities and facilitates referral development contacts in coordination with the clinical partnership team(s).

6. Reviews posted material, new policies, procedures or protocols, staff development announcements, communication log, etc., as needed.

7. Functions within the guidelines of the facility’s Code of Ethics and in accordance with corporate compliance.

8. Assists in promoting and ensuring the organization’s values, mission, goals, and objectives are understood and actively supported by the employees.

9. Performs other duties as assigned.

Qualifications

Education and Experience

Position requires master’s degree in social work or related field. Position requires a minimum of 5 years’ experience in a behavioral healthcare setting, preferably with clients with mental health and SUD and experience with senior level management. Licensed in clinical social work or professional counseling, strongly preferred.

Additional Requirements

• Position requires incumbent to have a valid driver’s license and acceptable driving record.

• Clearance of criminal background, TB test, and any other mandatory state/federal requirements.

• Current CPR and First Aid certification

Skill Competencies

• Demonstrates the ability to lead and promote active communication with department leaders and team members throughout the Company.

• Demonstrates excellent verbal and written communication skills; communicates clearly and concisely with clients, families, referral partners, and all members of the interdisciplinary team.

• Demonstrates an understanding of admission and discharge criteria; able to provide clinical recommendations for level of care placement.

• Demonstrates strong leadership skills; identifies and overcomes challenges, celebrates successes, enhances program effectiveness and efficiency.

• Demonstrates knowledge of and adherence to all licensures, accreditations and contract requirements.

• Demonstrates knowledge of and adherence to all state and federal laws related to business operations.

• Demonstrates a working knowledge of behavioral health management practices and clinical operations.

• Demonstrates the ability to leverage and analyze data to maintain an operational pulse, ensuring ongoing achievement of operational, financial, clinical and regulatory objectives.

• Demonstrates a high level of emotional intelligence and core values alignment.

STR Behavioral health Cedar Creek provides equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunities apply to all terms and conditions of employment. STR Behavioral Health Cedar Creek reserves the right to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains “At-Will.”

Overview
Are you passionate about making a positive impact on people's lives? Do you thrive in a collaborative environment where you can be part of an interdisciplinary team dedicated to restoring the health and well-being of clients? Look no further – VNS Health Personal Care is seeking compassionate and skilled Certified Home Health Aides like you

What You Will Do

• Provide personal care and support, including ambulation, transfers, ostomy care, and assistance with medical equipment and self-administered medication.
• Monitor vital signs, observe and report client conditions, and adhere to infection control practices.
• Assist with personal hygiene, nutrition, fluid intake, and light housekeeping.
• Ensures client rights and confidentiality.

Qualifications

• Satisfactory completion of New York State Health Department approved HHA Training Program or Equivalency.
• Sixth (6) grade reading comprehension level. 
• Writing and math skill level to the extent necessary for the successful and safe performance of required job functions. 
• Must be at least eighteen (18) years of age.

Physical Requirements

• Full range of body motion, including handling and lifting adult clients. 
• Standing and walking for extensive periods, as well as bending and climbing stairs. 
• Commonly lifts, carries, and maneuvers items weighing more than 50 lbs.

Compensation:

• $19.50 - $22.00 per hour

Location Address:

Compensation Pay Range:

Summary:

How you grow, learn and thrive matters here.
• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system

Responsibilities:

Leadership & Operations

• Provide clinical leadership and direct supervision to hospice and home health RNs, LPNs, CNAs, and support staff.

• Oversee day-to-day operations ensuring efficient workflow, positive team engagement, and adherence to care standards.

• Serve as a resource and mentor for clinical staff, fostering continued learning and professional development.

Clinical Oversight

• Ensure delivery of high-quality, patient-centered care in compliance with federal, state, and accreditation standards.

• Conduct case reviews, monitor clinical documentation, and support care planning.

• Participate in on-call rotation as needed to support clinical operations.

Regulatory & Quality Management

• Maintain compliance with Medicare/Medicaid, state regulations, and agency policies.

• Support quality improvement initiatives, including audits, performance metrics, and corrective action plans.

• Lead patient safety efforts and ensure timely incident reporting and follow-up.

Collaboration & Communication

• Partner with physicians, social workers, therapists, and interdisciplinary team members to deliver coordinated care.

• Collaborate closely with administrative leadership on staffing, budgeting, and strategic planning.

• Build positive relationships with patients, families, and the community.

Qualifications:

Current and active RN license in the state of New Mexico or out of state-compact license

Bachelor’s degree in Nursing (BSN) required; Master’s degree preferred.

Minimum 3–5 years of nursing experience in hospice, home health, or related field.

Previous leadership or supervisory nursing experience strongly preferred.

Strong knowledge of hospice philosophy and home health regulations

Excellent communication, problem-solving, and team leadership skills.

We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

Learn more about our employee benefits.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.