Remote UM Medical Director & Physician Advisor

Alignment Healthcare USA, LLC in; Orange (CA); Remote; 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 Medicare populations. The role reports to the Senior VP of Clinical Operations and collaborates with Quality and Provider Relations to optimize care and approvals.

The candidate will conduct CMS-guided reviews, advise on appropriateness of care, and participate in medical oversight. Mon-Fri 8-5 with some weekend requirements; salary range disclosed; Equal Opportunity Employer.

Qualifications

• MD degree with residency in internal medicine.
• Board certification and current, unrestricted medical license in the US.
• Experience in hospital-wide or skilled nursing facility settings is preferred.
• Knowledge of CMS guidelines, NCDs, LCDs and Milliman guidelines.

Responsibilities

• Perform second level reviews per CMS, NCD, LCD and Milliman guidelines.
• Provide appropriate care classifications and continued stay reviews.
• Serve as Physician member of the utilization review team.
• Act as liaison between medical staff, utilization review, and payers.
• Review denial processes, appeals and grievances.
• Develop UM protocols and accompany training of staff.
• Provide CME to regional medical officers and chair Medical Quality Committee.

Skills

Excellent communication skills

Rapport-building

Utilization management knowledge

Team collaboration

Medical staff governance

Education

MD degree with internal medicine residency

Board Certification

Current medical license in US

Job description

Alignment Health is seeking a Remote UM Medical Director/Physician Advisor to lead utilization management for Medicare populations. The role reports to the Senior VP of Clinical Operations and collaborates with Quality and Provider Relations to optimize care and approvals.

The candidate will conduct CMS-guided reviews, advise on appropriateness of care, and participate in medical oversight. Mon-Fri 8-5 with some weekend requirements; salary range disclosed; Equal Opportunity Employer.