Remote UM Medical Director & Utilization Lead

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

Job summary

Alignment Health seeks a Remote UM Medical Director/Physician Advisor to lead medical necessity reviews, ensure appropriate care levels, and collaborate with regional Medical Officers and Extensivists. This senior physician role emphasizes quality oversight, CMS compliance, and payer liaison work.

The position reports to the Senior VP of Clinical Operations and supports programs to optimize inpatient and outpatient service use while maintaining high standards of patient care.

Qualifications

• Medical school completed and specialty residency (preferably internal medicine).
• Board Certification.
• Current, non‑restricted medical license in the state or US territory where decisions are made.

Responsibilities

• Perform second level reviews for Medicare/CMS guidelines (NCD/LCD/Milliman).
• Provide appropriate level of care classifications and continued stay reviews.
• Act as liaison between medical staff, utilization review and payers.
• Review the denial process, appeals and grievances.
• Serve as Physician member of the utilization review team.
• Develop Utilization Management protocols and auto‑approvals.
• Provide CME and clinical oversight to officers and staff.
• Educate providers on UM processes and regulations.

Skills

Communication skills

Attention to detail

Team collaboration

Education

MD/DO degree

Board Certification

Medical license (US state)

Job description

Alignment Health seeks a Remote UM Medical Director/Physician Advisor to lead medical necessity reviews, ensure appropriate care levels, and collaborate with regional Medical Officers and Extensivists. This senior physician role emphasizes quality oversight, CMS compliance, and payer liaison work.

The position reports to the Senior VP of Clinical Operations and supports programs to optimize inpatient and outpatient service use while maintaining high standards of patient care.