Regional Medical Director, Non-Acute Utilization Management (Remote)

Alignment Healthcare Inc.; Fresno (CA); Híbrido; USD 262 000 - 393 000; Tempo integral

Resumo da oferta

Alignment Health seeks an experienced Regional Medical Director, Non-Acute Utilization Management, to lead market-level non-acute UM programs, drive medical necessity decisions, and collaborate across networks. This senior physician role combines strategic oversight with hands-on leadership in prior authorization, referral management, and care transitions.

You will partner with networks, Manage care leaders, and analytics teams to improve MLR, Star Ratings, and patient outcomes while ensuring

Qualificações

• MD or DO degree with active medical license.
• Board certification in an ABMS- or AOA-recognized specialty.
• Experience with Medicare Advantage, utilization management, and value-based care.
• Experience with outpatient prior authorization workflows and provider education.

Responsabilidades

• Lead market-level non-acute utilization management programs including prior authorization and approvals.
• Engage with PCPs, specialists, hospitals, and delegated groups to improve utilization performance.
• Oversee peer-to-peer reviews and medical necessity determinations; monitor trends.
• Drive post-discharge care transitions and SNF utilization management.
• Support CMS compliance, quality initiatives, and Star Ratings improvement.

Conhecimentos

Medicare Advantage

Managed Care Operations

Medical Necessity

Prior Authorization

Provider Engagement

Data Analysis

Quality & Star Ratings

Communication Skills

Cross-Functional Collaboration

Leadership

Formação académica

MD/DO

ABMS/AOA Board Certification

Active Medical License

Family/Internal Medicine Board Certification

Descrição da oferta de emprego

Alignment Health seeks an experienced Regional Medical Director, Non-Acute Utilization Management, to lead market-level non-acute UM programs, drive medical necessity decisions, and collaborate across networks. This senior physician role combines strategic oversight with hands-on leadership in prior authorization, referral management, and care transitions.

You will partner with networks, Manage care leaders, and analytics teams to improve MLR, Star Ratings, and patient outcomes while ensuring