Senior Vice President, Market Operations

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 Senior Vice President (SVP), Market Operations provides enterprise-wide executive leadership over market operations and is accountable for performance, scalability, and long-term sustainability across all geographies. This leader will serve as a strategic advisor and partner to enterprise leadership, ensuring market strategies translate into measurable financial, quality, compliance, and growth outcomes. The SVP, Market Operations is responsible for defining and advancing the enterprise market operating model, leading transformation initiatives, and driving sustainable improvement in medical cost management, risk adjustment, Stars performance, provider value based performance, and member experience. The role also establishes enterprise-wide performance governance and ensures cross-functional integration to achieve long-term organizational objectives.

Responsibilities:

Enterprise Market Strategy and Performance Accountability: 

• Translate enterprise strategy into scalable market operating plans with clear and measurable financial, operational and quality outcomes.
• Provide executive oversight and accountability for market level performance across all regions, including but not limited to medical loss ratio (MLR), utilization management, quality performance, Stars, risk adjustment, provider performance and engagement, member experience, contracting, medical cost management, compliance, membership growth and retention.
• Establish standardized performance management frameworks across markets, including KPI governance, business reviews, escalation protocols, and corrective action planning.
• Drive accountability with Market Presidents and functional leaders to achieve annual operating plans and multi-year strategic objectives.
• Provide risk adjustment performance accountability oversight across markets, ensuring consistent coding accuracy, provider engagement, and documentation integrity to optimize RAF performance and support CMS compliance and financial outcomes.
• Advance value-based care performance in collaboration with Market Presidents to strengthen provider performance and engagement under Shared Risk, Global Risk, Gain Share and other emerging payment models.
• Leverage advanced analytics and data, including but not limited to claims, appeals, authorizations, clinical, HEDIS and pharmacy, to drive CMS compliance, quality improvement and performance optimization.

Operational Excellence and Transformation: 

• Define, implement and continuously evolve the market operating model to ensure scalability, consistency, and operational excellence across all markets.
• Lead cross-market transformation initiatives focused on cost containment, quality improvement and operational efficiency.
• Drive implementation of risk adjustment optimization initiatives, standardizing workflows, tools, and provider processes to improve coding completeness, documentation accuracy, and overall RAF performance consistency across markets.
• Identify systemic barriers to performance and implement innovative, enterprise-level solutions to improve outcomes and reduce inefficiencies.
• Ensure operational readiness and executive excellence for market expansion, new product launches, regulatory changes and emerging business models.

Executive Cross-Functional Leadership: 

• Partner with enterprise leadership and cross-functional teams, including Network Management, Provider Operations, Finance, Quality, Stars, Utilization Management, Risk Adjustment, Clinical Operations, Compliance, Sales and Product, to align performance metrics and governance frameworks that drive achievement of financial and quality objectives.
• Drive enterprise alignment to ensure market priorities influence corporate strategy, investment decisions and resource allocation decisions.
• Leverage market intelligence, competitive insights and regulatory trends to inform enterprise strategy and market positioning.

Financial Stewardship and Risk Oversight: 

• Provide executive oversight of market P&L performance, including MLR,  revenue optimization, medical expense management, and margin expansion.
• Lead enterprise market planning, including annual operating plans, long-term planning and budgeting in partnership with Market Presidents and Finance.
• In collaboration with the Market Presidents, oversee risk pool performance and value based arrangements, ensuring financial transparency, reporting integrity, and strategic alignment with providers and enterprise objectives.
• Oversee the financial impact of risk adjustment performance across markets, ensuring RAF accuracy, revenue integrity, and proactive identification of risks and opportunities that affect Medicare Advantage margin performance.
• Identify financial risks and proactively implement mitigation strategies to protect enterprise performance.
• Drive accountability for achieving sustainable margin improvement while maintaining quality and compliance standards.

Growth, Expansion & Market Sustainability

• Partner with Market Presidents, Sales, Product, and Contracting leadership to drive market expansion, network strategy, and competitive positioning.
• Ensure operational readiness and scalability for new market entry, product expansion initiatives and membership growth.
• Ensure risk adjustment readiness and scalability in new and expanding markets, embedding coding accuracy, provider education, and documentation workflows into market entry and growth strategies.
• Drive and execute provider engagement strategies that strengthen provider partnerships and long-term market stability.

Leadership & Talent Development: 

• Build and sustain a high-performance culture grounded in accountability, transparency, collaboration, and continuous performance improvement across markets.
• Serve as an executive role model, reinforcing Alignment Health’s values and leadership standards.
• Provide executive coaching and strategic guidance to market leadership teams.
• Lead organizational change management efforts to ensure successful adoption of strategic initiatives.

Additional Strategic Responsibilities

• The scope of this role and its responsibilities will continue to evolve to support enterprise-wide strategic initiatives and organizational priorities.
• Lead or support high-impact, cross-functional initiatives and special projects as assigned by executive leadership.
• Continuously evaluate and evolve the market operating model to align with enterprise strategy, industry trends, and emerging business needs.

Supervisory Responsibilities:

Oversees assigned staff that support the needs of the markets. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Required Skills and Experiences:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

Minimum Experience:

• 12–15+ years of progressive leadership experience in healthcare, with significant experience in Medicare Advantage.
• 10+ years of executive leadership experience managing large, multi-market teams and complex operations.

Education/Licensure:

• BA/BS Degree in business or a relevant field is required; an MBA is preferred.
• Additional Skills and Qualifications:
• Deep expertise in Medicare Advantage operations, including Stars, risk adjustment, medical management, network strategy, and regulatory requirements.
• Demonstrated success leading  enterprise-scale operational and financial performance improvement initiatives.
• Deep knowledge of risk adjustment, coding accuracy, documentation integrity, provider education and engagement strategies, prospective and retrospective chart review programs, and CMS audit readiness and compliance.
• Proven ability to influence executive stakeholders and drive cross-functional alignment in a matrixed environment.
• Strong strategic, analytical and problem solving capabilities, with the ability to translate insights into action.
• Experience developing and executing network strategies and market performance initiatives.
• Experience leading multi-state, multi-market health plan operations.
• Experience working with delegated and non-delegated provider models.
• Strong understanding of provider contracting and payment methodologies, including  Hospitals (DRG, per diem), Physicians (RBRVS, FFS, Capitation), value based arrangements and provider incentives.
• Excellent knowledge of managed care finance Strong interpersonal, relationship management, and executive communication skills, with the ability to convey complex information clearly.
• Proven ability to foster collaboration, value diverse perspectives, and gain alignment and buy-in for organizational initiatives.
• Excellent Microsoft Office skills, including Word and Excel Ability to travel up to 40%, as needed
• Available for evenings / weekends and extended work hours as needed

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

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.

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.

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 [email protected].