Duals Director

Job Number: 2611

Workplace Type:

Position Title: Duals Director

External Description:

Duals Director

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. 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 community.

 

Position Summary:

This position requires significant knowledge of health plan operations and individual must have previous experience working with Medi-cal and Medicare operations. This position will be primarily supporting the Dual eligible program and will be helping to develop a framework to manage dual eligible members more effectively.

 

General Duties/Responsibilities:

(May include but are not limited to)

 

• Duals Director will be responsible for ensuring program activities are completed in a high quality and timely manner and ensuring compliance with all regulatory guidelines such as Medicaid (Medi-Cal) and Medicare
• Partner with various departments to support Dual eligible program
• Knowledge of health plan operations including eligibility, claims, Medi-Cal, Medicare, Network, IPA-Model, SNP Model of Care, Products, among others
• Implement new programs and workflows
• Initiates project by working with sponsor(s) to develop project scope including goals, objectives, milestones, and deliverables.
• Works with the project sponsor(s), business manager, functional managers in gathering business requirements, current state assessments and/or project requirements to develop preliminary project documents.
• Works with strategic project stakeholders to develop and oversee project status reports including: key accomplishments, risks, issues, action items, upcoming activities, deliverable examples, etc.
• Lead project status update meetings with the strategic project Operating Committee.
• Executes the project by leading the work of the project resources (internal and/or external) in a matrixed environment.
• Ensures project team is actively participating, collaborating and coordinating amongst team members as well as with other projects and/or business operations.
• Performs business analyst functionalities including: documenting future state business and technical requirements, documenting future state process flow diagrams, developing design documents, etc.
• Monitors and controls all aspects of the project by measuring progress and correcting course when project goes beyond scope or is not meeting goals and objectives.
• Ensures project remains on timeline by managing schedules and resources and removing barriers.

 

Minimum Requirements:

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 accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. Minimum Experience:
   1. 3+ years of Health Plan Project Management Experience working with Medi-cal or Medicare programs
2. Education/Licensure:
   1. Bachelor’s degree in health care, business administration, or related field of study (or equivalent work experience) required.
   2. Project Management Certificate
3. Other:
   1. Proficient with the use of Word, Excel, PowerPoint, Visio, Project and other Microsoft Office Suite products.
   2. Moderate to strong skills in quantitative analysis (including SQL), qualitative analysis, and problem-solving.
4. Work Environment:

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

 

1. 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.
2. 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.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Duals Director

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

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].