Regional Medical Director, Non-Acute Utilization Management

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

Job summary

Alignment Health, a fast-growing national health care company, seeks a Regional Medical Director for Non-Acute Utilization Management to lead market-level non-acute UM programs, ensure medical necessity determinations, and optimize care and costs across networks. The role partners with leadership to advance MLR, Star Ratings, and patient experience while maintaining CMS compliance.

Ideal candidates hold an MD/DO with board certification, have 5+ years in utilization management, and excel in

Qualifications

• MD or DO degree with active medical license
• Board certification in Family Medicine or Internal Medicine preferred
• 5+ years in Utilization Management or related field

Responsibilities

• Lead non-acute utilization management programs and prior authorization.
• Engage with PCPs, specialists, hospitals, and delegated groups to improve referral patterns.
• Monitor CMS, InterQual/MCG criteria adherence and quality metrics.
• Collaborate with UM operations to improve turnaround times and patient outcomes

Skills

Utilization Management

Provider Engagement

Data Analysis

Executive Presentation

Cross-Functional Collaboration

Education

MD/DO

Board Certification (Family/Internal Medicine)

Job description

Alignment Health, a fast-growing national health care company, seeks a Regional Medical Director for Non-Acute Utilization Management to lead market-level non-acute UM programs, ensure medical necessity determinations, and optimize care and costs across networks. The role partners with leadership to advance MLR, Star Ratings, and patient experience while maintaining CMS compliance.

Ideal candidates hold an MD/DO with board certification, have 5+ years in utilization management, and excel in