Remote UM Medical Director & Physician Advisor

Alignment Health; Northern (KY); Hybrid; USD 262,000 - 393,000; Full time

Job summary

Alignment Health is seeking a Remote UM Medical Director/Physician Advisor to lead utilization management for inpatients, outpatients, and facilities, ensuring medical necessity and compliance. You will perform reviews, assign care levels, and collaborate with medical staff and payers to promote appropriate care.

The role reports to the Senior VP of Clinical Operations, with remote access to Alignment Health’s web‑based portal and a focus on quality outcomes, training, and interdisciplinary

Qualifications

• 3–5 years hospital-wide or skilled nursing facility clinical care, quality management, utilization and case management.
• Completion of medical school and specialty residency (preferably internal medicine). Board Certification.
• Current, non‑restricted medical license for the state of practice.

Responsibilities

• Conduct second level reviews for inpatient, outpatient, Skilled Facility levels of care and Pharmacy per Medicare/CMS and Milliman guidelines.
• Provide appropriate level of care classifications and continued stay reviews.
• Liaise with medical staff, utilization review and third-party payers to promote appropriate levels of medical care.
• Review the entire claim denial process, including pending claims, appeals and grievances.
• Serve as a Physician member of the Utilization Review team.
• Ensure appropriate service utilization by monitoring over- and under-utilization.
• Develop UM protocols with Interdisciplinary Team and conduct training.
• Serve as Subject Matter Expert during concurrent reviews.
• Chair Medical Quality Committee and provide clinical oversight of outcomes.

Skills

Communication skills

Attention to detail

Team collaboration

Interpersonal skills

Education

Medical degree

Residency in internal medicine

Board certification

State medical license

Job description

Alignment Health is seeking a Remote UM Medical Director/Physician Advisor to lead utilization management for inpatients, outpatients, and facilities, ensuring medical necessity and compliance. You will perform reviews, assign care levels, and collaborate with medical staff and payers to promote appropriate care.

The role reports to the Senior VP of Clinical Operations, with remote access to Alignment Health’s web‑based portal and a focus on quality outcomes, training, and interdisciplinary