Remote Regional Medical Director, Non-Acute UM

E2E Alignment Healthcare USA, LLC; Texas; Hybrid; USD 262,000 - 393,000; Full time

Job summary

Alignment Health seeks a Regional Medical Director, Non-Acute Utilization Management, to lead market-level non-acute UM programs across assigned Texas markets. You will drive prior authorization, referral management, and medical necessity reviews, partnering with providers and delegated groups to optimize utilization and cost of care.

The role requires MD/DO with Texas license, ABMS/AOA board certification, and 5–10 years in UM leadership within managed care; travel and remote/hybrid work in

Qualifications

• MD/DO with active Texas medical license
• Board certification in ABMS or AOA
• 5–10 years of Utilization Management clinical practice
• Leadership experience in managed care or value-based care environments

Responsibilities

• Lead market-level non-acute UM programs including prior authorization, referral management, and site-of-service optimization
• Partner with PCPs, specialists, hospitals, and delegated groups to improve utilization performance
• Perform peer-to-peer medical necessity reviews and support electronic prior authorization initiatives
• Coordinate post-acute transitions and SNF utilization management to reduce readmissions and variability
• Oversee regulatory, CMS, and quality requirements to improve Star Ratings and member outcomes
• Support analytics and operational teams to drive continuous program improvement

Skills

Utilization management

Medicare Advantage

Clinical leadership

Provider engagement

Data analytics

Education

MD/DO degree

Job description

Alignment Health seeks a Regional Medical Director, Non-Acute Utilization Management, to lead market-level non-acute UM programs across assigned Texas markets. You will drive prior authorization, referral management, and medical necessity reviews, partnering with providers and delegated groups to optimize utilization and cost of care.

The role requires MD/DO with Texas license, ABMS/AOA board certification, and 5–10 years in UM leadership within managed care; travel and remote/hybrid work in