Remote Regional Medical Director, Non-Acute UM

Alignment Health; Asheboro (NC); Remote; USD 262.000 - 393.000; Vollzeit

Zusammenfassung

Alignment Health is seeking a Remote Regional Medical Director for Non-Acute Utilization Management to lead market-level non-acute UM programs, ensure medical necessity decisions, and drive optimization of CMS-compliant pathways across networks. The role emphasizes collaboration with PCPs, hospitals, and delegated groups to improve referral patterns and utilization performance.

The position requires a medical degree (MD/DO), NC licensure, and leadership experience in Medicare Advantage or

Qualifikationen

• MD or DO degree from an accredited institution.
• Board certification in an ABMS- or AOA-recognized specialty.
• Active, unrestricted medical license in NC.

Aufgaben

• Lead physician oversight of market-level non-acute UM programs including prior authorization and site-of-service optimization.
• Engage with PCPs, specialists, hospitals, and medical groups to improve utilization performance.
• Conduct peer-to-peer consultations for complex outpatient and non-acute requests and oversee medical necessity reviews.
• Collaborate with UM operations to improve authorization turnaround times and first-pass approval rates.
• Ensure compliance with CMS, NCQA, and state regulatory requirements during clinical decisions.
• Coordinate post-discharge transitions and care management across networks.

Kenntnisse

Utilization Management

Leadership

Clinical Operations

Provider Engagement

Analytics

Ausbildung

MD or DO degree

Board certification in Family Medicine or Internal Medicine

Jobbeschreibung

Alignment Health is seeking a Remote Regional Medical Director for Non-Acute Utilization Management to lead market-level non-acute UM programs, ensure medical necessity decisions, and drive optimization of CMS-compliant pathways across networks. The role emphasizes collaboration with PCPs, hospitals, and delegated groups to improve referral patterns and utilization performance.

The position requires a medical degree (MD/DO), NC licensure, and leadership experience in Medicare Advantage or