Remote Regional Medical Director, Non-Acute Utilization

Alignment Healthcare USA; United States; Remote; USD 250,000 - 350,000; Full time

Job summary

Alignment Health seeks a Remote Regional Medical Director, Non-Acute Utilization Management (RMD Non-Acute UM) to lead market-level non-acute UM programs, drive utilization efficiency, and improve quality and total cost of care for assigned provider networks across markets.

You will partner with the Regional Medical Officer and serve as the physician leader for Prior Authorization, Referral Management, Utilization Management, and related operations, while supporting value-based care initiatives

Responsibilities

• Non-Acute Utilization Management Leadership. Lead physician oversight of market-level non-acute UM programs—including prior authorization, referral management, outpatient medical necessity determinations, DME, home health, advanced imaging, Part B medications, and site-of-service optimization—ensuring CMS regulations, InterQual/MCG criteria, and evidence-based guidelines.

Job description

Alignment Health seeks a Remote Regional Medical Director, Non-Acute Utilization Management (RMD Non-Acute UM) to lead market-level non-acute UM programs, drive utilization efficiency, and improve quality and total cost of care for assigned provider networks across markets.

You will partner with the Regional Medical Officer and serve as the physician leader for Prior Authorization, Referral Management, Utilization Management, and related operations, while supporting value-based care initiatives