Remote Regional Medical Director, Non-Acute UM

E2E Alignment Healthcare USA, LLC; California; Híbrido; USD 262 000 - 393 000; Tempo integral

Resumo da oferta

Alignment Health is seeking a Remote Regional Medical Director for Non-Acute Utilization Management. The role leads market-level non-acute UM programs, ensures CMS and evidence-based guidelines, and partners with providers to optimize utilization and outcomes.

The position requires a Maryland? No, CA license, MD/DO, and senior leadership experience in utilization management and Medicare Advantage. Local travel and hybrid work arrangements apply.

Qualificações

• MD or DO degree required and board certification.
• Active, unrestricted medical license in CA.
• Experience with Medicare Advantage, UM operations, and value-based care.
• Strong experience in clinical analytics and provider engagement.

Responsabilidades

• Lead market-level non-acute UM programs and prior authorization workflows.
• Collaborate with PCPs, specialists, hospitals, and delegated groups to improve utilization and performance.
• Oversee medical necessity reviews, denials, appeals, and trend analysis.
• Drive post-discharge care coordination and transitions to lower levels of care when appropriate.
• Improve authorization turnaround times and first-pass approval rates with UM operations.
• Ensure compliance with CMS/NCQA requirements and regulatory standards.
• Support SNF and post-acute utilization management and site-of-service optimization.

Conhecimentos

Leadership

Utilization Management

Medicare Advantage

Clinical analytics

Provider engagement

Communication

Formação académica

MD or DO

Board certification

Active medical license in CA

Descrição da oferta de emprego

Alignment Health is seeking a Remote Regional Medical Director for Non-Acute Utilization Management. The role leads market-level non-acute UM programs, ensures CMS and evidence-based guidelines, and partners with providers to optimize utilization and outcomes.

The position requires a Maryland? No, CA license, MD/DO, and senior leadership experience in utilization management and Medicare Advantage. Local travel and hybrid work arrangements apply.