Remote Regional Medical Director, Non-Acute UM

Alignment Healthcare USA, LLC in; Fresno (CA); Hybrid; USD 262,000 - 393,000; Full time

Job summary

Alignment Health seeks a Regional Medical Director, Non-Acute Utilization Management (RMD Non-Acute UM) to lead non-acute UM programs in Fresno, CA and adjacent markets. You will oversee prior authorization, referral management, and medical necessity, partnering with PCPs, specialists, and delegated groups to optimize utilization and quality metrics.

Ideal candidates hold an MD/DO with board certification, CA license, 5–10 years in UM, and 3+ years of leadership.

Qualifications

• Experience: 5–10 years in Utilization Management clinical practice.
• Leadership: 3+ years in managed care or related environments.
• Education: MD or DO with board certification and CA license.

Responsibilities

• Lead market-level non-acute UM programs, including prior authorization and referral management.
• Ensure medical necessity reviews and CMS guideline adherence.
• Collaborate with PCPs, hospitals, and delegated groups to improve utilization performance.
• Advance outcomes like MLR, Star Ratings, and patient experience.
• Support implementation of electronic prior authorization and provider education.

Skills

Utilization Management

Medical Necessity

Leadership

Provider Engagement

CMS Regulations

Education

MD or DO

Board Certification

CA Medical License

Job description

Alignment Health seeks a Regional Medical Director, Non-Acute Utilization Management (RMD Non-Acute UM) to lead non-acute UM programs in Fresno, CA and adjacent markets. You will oversee prior authorization, referral management, and medical necessity, partnering with PCPs, specialists, and delegated groups to optimize utilization and quality metrics.

Ideal candidates hold an MD/DO with board certification, CA license, 5–10 years in UM, and 3+ years of leadership.