Remote Regional Medical Director, Non-Acute UM

Alignment Health; San Antonio (TX); Hybrid; USD 262,000 - 393,000; Full time

Benefits offered by this job

Remote/hybrid work option

Job summary

Alignment Health seeks a market-facing RMD Non-Acute UM to optimize non-acute utilization and quality across assigned networks. You will lead physician oversight of UM programs, drive Prior Authorization and Referral Management, and partner with providers to improve cost and care quality.

The role requires MD/DO with board certification, Texas license, and 5–10 years in UM with leadership experience in managed care. Local market presence with remote work options and travel within the market.

Qualifications

• MD or DO with board certification in an ABMS- or AOA-recognized specialty.
• Active Texas medical license and ongoing professional development.
• Experience with Medicare Advantage, utilization management, and quality programs.

Responsibilities

• Lead market-level non-acute UM programs, including prior authorization and site-of-service optimization.
• Partner with PCPs, hospitals, and delegated groups to improve utilization performance.
• Oversee medical necessity reviews, appeals, and electronic prior authorization initiatives.
• Coordinate care transitions and post-discharge activities to reduce readmissions.

Skills

Utilization Management

Leadership

Provider Engagement

Clinical Operations

Education

MD or DO

Board certification

Texas medical license

Job description

Alignment Health seeks a market-facing RMD Non-Acute UM to optimize non-acute utilization and quality across assigned networks. You will lead physician oversight of UM programs, drive Prior Authorization and Referral Management, and partner with providers to improve cost and care quality.

The role requires MD/DO with board certification, Texas license, and 5–10 years in UM with leadership experience in managed care. Local market presence with remote work options and travel within the market.