Alignment Health

This remote Utilization Management Nurse role supports Alignment Health's mission to serve seniors and chronically ill patients by reviewing pre-service authorization requests for medical necessity. The position requires an active California RN or LVN license and involves applying CMS and Milliman Care Guidelines to determine coverage for inpatient and outpatient services. Key responsibilities include collaborating with providers and medical directors, verifying eligibility and coding accuracy, and managing turnaround times for referrals. The role appeals to nurses seeking a fast-paced, production-driven environment with opportunities for professional growth within a mission-driven company. The schedule is Monday through Friday with occasional weekend rotations, operating within Pacific, Mountain, or Central time zones.

The Sr. Director, Risk Adjustment Data & Analytics role is a senior leadership position within Alignment Health's data operations team, dedicated to advancing Medicare Risk Adjustment programs. The individual oversees the end-to-end data ecosystem, ensuring integrity and compliance while leading a multidisciplinary team of analysts and engineers. Key responsibilities include driving analytical insights for executive decision-making, maintaining rigorous data governance for audit readiness, and partnering with finance and clinical stakeholders to optimize revenue and care outcomes. This position appeals to candidates seeking to lead high-impact work in a mission-driven organization that prioritizes senior care. The role offers significant growth opportunities within a fast-growing company and is available in a remote work arrangement.