Job Overview
Location
Anywhere in the U.S.
Job Type
Full-time
Category
Human Resources
Date Posted
May 2, 2026
Full Job Description
📋 Description
- • As Medical Director, Utilization Management at Alignment Healthcare, you will play a critical role in ensuring appropriate, high-quality, and cost-effective care for seniors and chronically ill patients by overseeing utilization review processes and supporting clinical decision-making aligned with CMS guidelines.
- • Day to day, you will conduct second-level clinical reviews for medical necessity and treatment appropriateness, serve as a liaison between medical staff and payers, lead interrater reliability testing, develop UM protocols, and chair the Medical Quality Committee to drive quality outcomes.
- • You will join a mission-driven, fast-growing team at Alignment Health dedicated to transforming senior care, where innovation and compassion are central to improving lives through value-based healthcare solutions.
- • In this role, you will deepen your expertise in utilization management, healthcare reimbursement, and clinical leadership while influencing organizational quality and efficiency initiatives across inpatient, outpatient, and skilled care settings.
🎯 Requirements
- • Completion of medical school and specialty residency (preferably in internal medicine) with Board Certification
- • Current, non-restricted medical licensure in the state where services are provided
- • 3-5 years of experience in hospital-wide or skilled nursing facility roles involving clinical care, quality management, utilization, case management, or medical staff governance
- • Ability to build rapport with medical staff and leadership to gain approval for new utilization strategies
- • Excellent communication skills and strong attention to detail
- • Knowledge of current medical literature, healthcare delivery systems, reimbursement issues, and medical staff organizations
🏖️ Benefits
- • Opportunity to do meaningful work that improves and saves lives of seniors and chronically ill patients
- • Room for professional growth and innovation within a fast-growing, mission-driven organization
- • Remote work flexibility with access to web-based portal for clinical reviews
- • Collaborative, interdisciplinary team environment focused on transforming senior care
- • Equal Opportunity/Affirmative Action employer committed to diversity and inclusion
Skills & Technologies
About Alignment Healthcare, LLC
Alignment Healthcare is a health insurance company that focuses on providing personalized care for seniors and underserved populations. They operate a value-based care model, aiming to improve health outcomes and reduce costs through integrated care teams, technology, and data analytics. Their services include Medicare Advantage plans, chronic care management, and home-based care. Alignment Healthcare partners with providers and aims to deliver a seamless and high-quality healthcare experience for its members, emphasizing proactive and preventive care to keep individuals healthy and out of the hospital.
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