Medical Director – Utilization Management

Alignment Health

Medical Director overseeing Utilization Management to optimize patient care at Alignment Health. Leading clinical reviews, compliance, and collaboration with medical staff and management in a remote setting.

Posted 5/20/2026full-timeRemote • California • 🇺🇸 United StatesLead💰 $198,219 - $297,329 per yearWebsite

About the role

Key responsibilities & impact

Processes second level reviews in compliance with Medicare/CMS
Provides appropriate level of care classifications and continued stay reviews in compliance with CMS
Acts as a liaison between the medical staff, utilization review, and 3rd party payers
Reviews the entire claim denial process, including Appeals and Grievances
Serves as a Physician member of the utilization review team

Requirements

What you’ll need

Minimum of 3 years of experience in hospital-wide or skilled nursing facility position involving clinical care, quality management, utilization and case management, or medical staff governance required.
Completion of medical school and specialty residency (preferably in internal medicine) required.
Must have current, non-restricted licensure as required for clinical practice in the state of California.

Benefits

Comp & perks

Health insurance
401(k)
Paid time off

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization reviewcase managementquality managementclinical careclaim denial processappealsgrievances

Soft Skills

liaisoncommunication

Certifications

medical license