Remote Regional Medical Director, Non-Acute Utilization Management

Alignment Healthcare USA, LLC in; Charlotte (NC); Hybrid; USD 262.000 - 393.000; Vollzeit

Zusammenfassung

Alignment Health is seeking a Regional Medical Director, Non-Acute Utilization Management, to lead market-level non-acute UM programs and optimize clinical outcomes, utilization, and total cost of care. This leadership role partners with the Regional Medical Officer and works across prior authorization, referral management, care transitions, and network management to advance value-based care.

The position requires an MD/DO with board certification and an active NC license, plus five to ten years

Qualifikationen

• MD or DO with active license in NC and board certification in an appropriate specialty.
• Minimum five to ten years of utilization management leadership experience.
• Experience partnering with delegated medical groups and networks to improve performance.

Aufgaben

• Lead market-level non-acute UM programs, including prior authorization and referral management.
• Drive utilization performance, medical necessity oversight, and care coordination.
• Oversee post-discharge transitions and post-acute optimization in assigned markets.
• Collaborate with CAW, TOC, UM, analytics, and network partners on program design.
• Ensure CMS, NCQA, and regulatory compliance across the program.

Kenntnisse

Leadership

Utilization Management

Medical oversight

CMS guidelines

Provider engagement

Ausbildung

MD/DO

Board certification

NC medical license

Tools

InterQual/MCG criteria

CMS regulations

Health analytics

Jobbeschreibung

Alignment Health is seeking a Regional Medical Director, Non-Acute Utilization Management, to lead market-level non-acute UM programs and optimize clinical outcomes, utilization, and total cost of care. This leadership role partners with the Regional Medical Officer and works across prior authorization, referral management, care transitions, and network management to advance value-based care.

The position requires an MD/DO with board certification and an active NC license, plus five to ten years