Field Remote Provider Engagement Specialist Merced/Stanislaus County
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About this role
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.
Alignment Health is seeking a proactive, relationship-driven, and highly organized Provider Engagement Specialist to support our growing provider network in Merced/Stanislaus County, CA. In this field-based remote role, you will build strong relationships with physician practices and provider groups, helping improve quality, growth, retention, utilization, and risk adjustment performance while supporting network expansion.This position is ideal for a self-driven professional who enjoys building partnerships, analyzing provider performance, solving problems, and improving healthcare outcomes.
- Field-based role with approximately 80% travel throughout Merced/Stanislaus County, CA .
- Flexible, self-managed schedule
- Initial training may include shadowing an established market team in Raleigh, NC
- Occasional travel (1-2 times annually) for meetings, training, or conferences
- Mileage and travel expenses reimbursed per company policy
- Primarily Monday-Friday during provider office hours, with flexibility for occasional early morning, evening, or community events
- Build and maintain collaborative relationships with providers and office staff.
- Partner with providers to improve performance in growth, retention, AWVs, HEDIS gap closures, hospital and ER utilization, risk adjustment, and other quality metrics.
- Conduct provider onboarding and ongoing education regarding Alignment Health tools, programs, incentives, member benefits, Model of Care requirements, compliance requirements, and organizational initiatives.
- Develop provider training materials, implementation packets, and educational presentations.
- Serve as the primary point of contact for provider issues, including UM, prior authorizations, claims, eligibility, encounter data, provider rosters, and directory validation.
- Represent Alignment Health at provider meetings, trainings, and community events.
- Negotiate and implement physician and ancillary agreements and support provider credentialing and recruitment efforts.
- Maintain provider engagement documentation, tracking databases, activity reports, and meeting records.
- Attend staff meetings and perform special projects as assigned.
- Bachelor's degree (B.A. or B.S.) preferred; or equivalent combination of education and experience.
- Minimum of two (2) years of related experience and/or training.
- Experience in provider relations, provider contracting, network development, healthcare operations, managed care, IPA, HMO, medical group, or institutional provider environments required.
- Bilingual English/Spanish preferred.
- Experience working directly with physician practices and healthcare providers.
- Knowledge of Medicare Advantage, quality programs, risk adjustment, utilization management, and provider performance metrics.
- Strong relationship-building and interpersonal skills.
- Excellent verbal and written communication abilities.
- Strong presentation and facilitation skills.
- Strong analytical, quantitative, and problem-solving capabilities.
- Highly organized, detail-oriented, and self-motivated.
- Ability to work independently and collaboratively.
- Ability to effectively engage diverse provider audiences.
- Proficiency with Microsoft Office Suite (Word, Excel, and PowerPoint).
- Routinely required to travel by car throughout the assigned market (80% or more).
- Must maintain reliable transportation, a valid driver's license, and automobile insurance.
- Air travel required as needed.
- Extended or flexible work hours may occasionally be required.
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 careers@ahcusa.com.
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