San Antonio · Texas · United States
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Remote Regional Medical Director, Non-Acute Utilization Management (RMD Non-Acute UM) is a market-facing physician leader responsible for optimizing clinical outcomes, quality performance, utilization management, and total cost of care through non-acute clinical programs across assigned provider networks and markets. The role partners closely with the Regional Medical Officer and serves as the primary physician leader for Prior Authorization, Referral Management, Utilization Management, Clinical Operations, Care Anywhere (CAW), Case Management, Pharmacy, Network Management, and Quality. The RMD Non-Acute UM works directly with contracted network providers, delegated medical groups, and de-delegated non-acute functions to advance MLR, Star Ratings, member experience, and value-based care performance. Key outcomes include appropriate resource utilization, reduced avoidable post-acute placement, improved in-network referral capture, and measurable improvement in non-acute cost and quality performance.
Must reside in TEXAS, preferably San Antonio or El Paso