Regional Medical Director, Non-Acute UM

Alignment Healthcare Inc.; Charlotte (NC); Hybrid; USD 262,000 - 393,000; Full time

Job summary

Alignment Health is seeking a Regional Medical Director for Non-Acute Utilization Management in Raleigh/Charlotte. You will lead market-level non-acute UM programs, including prior authorization, referral management, and medical necessity oversight, aligning with CMS regulations and evidence-based guidelines.

The role emphasizes physician leadership, provider engagement, and performance improvement in MLR and Star Ratings, with field-based collaboration and remote work options in the

Qualifications

• MD/DO with active medical license in applicable state(s).
• Minimum five-ten years of Utilization Management clinical practice.
• Leadership experience in managed care, Medicare Advantage, IPA/MSO, or risk-bearing entities.

Responsibilities

• Lead physician oversight of market-level non-acute UM programs.
• Oversee prior authorization, referral management, and medical necessity determinations.
• Ensure CMS compliance, evidence-based guidelines, and appropriate care transitions.
• Drive performance improvements in MLR, Star Ratings, and member experience.
• Collaborate with CAW, TOC, Clinical Operations, UM, and Network partners.

Skills

Medicare Advantage

Utilization Management

Clinical leadership

CMS regulations

Provider engagement

HEDIS/Star Ratings

Education

MD or DO degree

Board certification in Family/Internal Medicine

Job description

Alignment Health is seeking a Regional Medical Director for Non-Acute Utilization Management in Raleigh/Charlotte. You will lead market-level non-acute UM programs, including prior authorization, referral management, and medical necessity oversight, aligning with CMS regulations and evidence-based guidelines.

The role emphasizes physician leadership, provider engagement, and performance improvement in MLR and Star Ratings, with field-based collaboration and remote work options in the