Director, Preferred Networks – Care Routing

🕒 March 3

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Design and lead the enterprise care routing strategy, aligning provider selection and referral pathways with organizational goals for quality, affordability, access, and member experience. • Define and maintain preferred network frameworks that segment providers based on performance, capacity, access, and clinical outcomes. • Establish clear, data-driven criteria for identifying high-performing providers while ensuring adequate access for members across geographies and specialties. • Own the development of network intelligence capabilities that integrate claims, utilization, clinical outcomes, access, and member demand data. • Evaluate network adequacy beyond regulatory compliance measures, assessing whether the network meaningfully meets member needs related to access, capacity, timeliness, specialty coverage, and care continuity. • Identify gaps, redundancies, or misalignments in the network that may impact care routing effectiveness or member experience. • Provide data-driven recommendations to adjust network composition, provider mix, or geographic coverage based on performance and access insights. • Design and embed care routing workflows within existing operational teams (e.g., UM, Care Management, Member Services, Provider Relations, Scheduling) to steer members to preferred providers while preserving access and choice. • Build, lead, and develop a small, high-performing team focused on network intelligence, care routing execution, and network adequacy analysis.

🎯 Requirements

• 10+ years of experience in healthcare network management, clinical operations, access strategy, or value-based care environments. • 5+ years of leadership experience managing teams or enterprise-level initiatives. • Demonstrated experience evaluating network adequacy, access, or provider capacity beyond regulatory compliance requirements. • Strong understanding of provider performance measurement, referral patterns, access standards, and utilization management. • Proven ability to translate data insights into operational workflows that influence care delivery and member access. • Experience operating effectively in complex, matrixed organizations. • Bachelor’s degree required in Healthcare Administration, Public Health, Business Administration, Nursing, or a related field. • Master’s degree preferred (e.g., MHA, MPH, MBA, MSN). • Preferred: Lean Six Sigma Black; PMP or Agile certification. • Required: Deep understanding of healthcare provider networks, network adequacy, access standards, and care delivery models. • Strong analytical skills with the ability to synthesize access, utilization, and performance data into actionable strategies. • Ability to balance member access, provider performance, and operational feasibility in care routing decisions. • Strong communication and executive presence, with the ability to influence clinical, operational, and network stakeholders. • Experience designing and operationalizing workflows across clinical and non-clinical teams.

🏖️ Benefits

• None