Remote UM Medical Director & Physician Advisor

Alignment Health; United States; Remote; USD 262,000 - 393,000; Full time

Job summary

Alignment Health is seeking a Remote UM Medical Director/Physician Advisor to drive utilization management and ensure high-quality patient care across inpatient and outpatient settings. The role reports to the Senior VP of Clinical Operations and collaborates with regional medical officers and extensivists via a web-based portal.

The position requires 3–5 years in hospital-wide or skilled nursing utilization, medical school completion, residency, and board certification, with an unrestricted US

Qualifications

• Completion of medical school and specialty residency (preferably internal medicine).
• Board certification and current, unrestricted medical license in the US.
• Experience in hospital-wide or skilled nursing facility utilization management preferred.

Responsibilities

• Perform second level reviews for medical necessity, treatment appropriateness and compliance.
• Act as liaison between medical staff, utilization review and payers to promote appropriate care levels.
• Review denial processes, appeals and grievances with CMS/Milliman guidance.
• Serve as Physician member of the utilization review team.
• Provide clinical oversight and participate in quality outcomes initiatives.

Skills

Leadership

Clinical governance

Utilization management

Medical reviews

CMS guidelines

Education

Medical degree (MD/DO)

Board certification

US medical licensure

Job description

Alignment Health is seeking a Remote UM Medical Director/Physician Advisor to drive utilization management and ensure high-quality patient care across inpatient and outpatient settings. The role reports to the Senior VP of Clinical Operations and collaborates with regional medical officers and extensivists via a web-based portal.

The position requires 3–5 years in hospital-wide or skilled nursing utilization, medical school completion, residency, and board certification, with an unrestricted US