Medical Director-Physical Health (Full-time Remote, North Carolina Based)
$211,172–$269,245 year
RemoteUnited States
Job Summary
Provide expert clinical oversight for physical health service requests, including authorization, level of care determinations, and appeals. Ensure integrity of utilization management activities by conducting initial, concurrent, and level of care reviews for inpatient and outpatient services while maintaining regulatory compliance. Participate in internal case reviews, organizational committees, and Office of Administrative Hearing processes to support clinical quality and care coordination. Apply medical necessity criteria and department workflows within the Alliance UM platform to complete expected case volumes efficiently. Maintain awareness of emerging trends, contribute to process improvement initiatives, and mentor peers within the Medical Management team.
Required Qualifications
- Graduation from an accredited Medical School
- M.D./D.O. degree
- Board certification in a relevant field
- At least four (4) years of postgraduate clinical experience
- Two (2) or more years of managed care and utilization management experience
- Current, active, and unrestricted license to practice medicine in North Carolina
- Qualifications to obtain a North Carolina Medical License
- Board certification for appropriate field of Medicine (American Board of Family Medicine or American Board of Internal Medicine)
- Knowledge of the information and techniques needed for diagnosis and treatment of medical issues
- Knowledge of Managed Care Principles
- Knowledge of recent developments in the field of medicine
- Microsoft Office Skills
- Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations
- Utilization Management experience
- Willingness to relocate
- Ability to work weekends and holidays
Desired Qualifications
- Reside in North Carolina
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