Remote Regional Medical Director, Non-Acute Utilization

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

Job summary

Alignment Health is seeking a market-facing Regional Medical Director, Non-Acute Utilization Management in North Carolina. You will lead non-acute UM programs, optimize CMS-based pathways, and partner with networks to improve cost and quality measures.

The role requires MD/DO, board certification, NC license, and 5–10 years in UM with leadership experience; travel is required for local markets, with a mix of remote and onsite collaboration to drive value-based care initiatives.

Qualifications

• MD or DO with active, unrestricted NC medical license.
• Board certification in an ABMS- or AOA-recognized specialty.
• Experience leading utilization management in Medicare Advantage or managed care.
• Knowledge of CMS requirements, HEDIS, and Star Ratings is beneficial.

Responsibilities

• Lead market-level non-acute UM programs including prior authorization and referral management.
• Engage providers to improve utilization performance and educate on referral practices.
• Oversee medical necessity reviews, authorization trends, and electronic prior authorization initiatives.
• Coordinate post-discharge transitions and post-acute utilization strategies with care teams.

Skills

Utilization Management

Leadership

Provider Engagement

Data Analysis

Education

MD or DO

Board certification

NC Medical License

Family Medicine/Internal Medicine board (preferred)

Job description

Alignment Health is seeking a market-facing Regional Medical Director, Non-Acute Utilization Management in North Carolina. You will lead non-acute UM programs, optimize CMS-based pathways, and partner with networks to improve cost and quality measures.

The role requires MD/DO, board certification, NC license, and 5–10 years in UM with leadership experience; travel is required for local markets, with a mix of remote and onsite collaboration to drive value-based care initiatives.