Remote Regional Medical Director, Non-Acute UM

Alignment Healthcare USA, LLC in; Raleigh (NC); Remote; USD 262,000 - 393,000; Full time

Job summary

Alignment Health in North Carolina seeks a Remote Regional Medical Director, Non-Acute Utilization Management (RMD Non-Acute UM). You will lead market-level non-acute UM programs, including prior authorization, medical necessity determinations, and provider engagement to optimize resource use and outcomes.

The role requires an MD/DO with ABMS or AOA board certification and an active NC medical license. Minimum five-ten years in utilization management leadership preferred.

Qualifications

• MD or DO medical degree required with ABMS/AOA board certification.
• Active, unrestricted NC medical license required; Family/Internal Medicine preferred.
• Experience leading non-acute utilization management and payer/provider collaboration.

Responsibilities

• Lead market-level non-acute UM programs, including prior authorization and medical necessity determinations.
• Engage with PCPs, specialists, and delegated groups to improve utilization performance.
• Oversee peer-to-peer consultations, appeals trends, and electronic prior authorization initiatives.
• Coordinate post-acute care transitions and SNF utilization management.
• Improve in-network referrals, site-of-service optimization, and adherence to CMS criteria.
• Monitor KPIs like MLR, Star Ratings, and referral trends.

Skills

Leadership

Utilization Management

Provider engagement

CMS guidelines

Education

MD or DO

Board certified in ABMS/AOA

NC medical license

Job description

Alignment Health in North Carolina seeks a Remote Regional Medical Director, Non-Acute Utilization Management (RMD Non-Acute UM). You will lead market-level non-acute UM programs, including prior authorization, medical necessity determinations, and provider engagement to optimize resource use and outcomes.

The role requires an MD/DO with ABMS or AOA board certification and an active NC medical license. Minimum five-ten years in utilization management leadership preferred.