Remote Medical Director — Physical Health

Medical Director – Physical Health (Full‑time Remote, North Carolina‑Based) Alliance Health Occupation: Medical and Health Services Managers • Location: Charlotte, NC • Job Type: Full Time (30 Hours or More) The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence‑based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination. This role permits primarily remote work, with occasional on‑site reporting as needed. Residency or relocation to North Carolina is strongly preferred. Work may include weekends and holidays based on operational requirements. Responsibilities & Duties Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care. Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level‑of‑care determinations for inpatient and outpatient services. Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards. Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service; complete expected case volume as required. Follow department processes—defined by approved Alliance policies, desk procedures, and workflows—to complete timely utilization reviews in Alliance’s UM platform and perform tasks efficiently. Apply established workflows and maintain quality case reviews to ensure consistent decision making, documentation accuracy, and adherence to regulatory compliance. Support the Clinical Operations Department through active participation in organizational committees, including Clinical Quality Review, Transition of Care Rounds, and Overturn Committee. Provide clinical guidance and leadership to promote collaboration between medical, behavioral, and care management teams. Participate in mediation activities and Office of Administrative Hearing (OAH) processes as required, providing clinical expertise and documentation support. Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services. Contribute to process‑improvement initiatives aimed at enhancing clinical quality, efficiency, and member outcomes. Support cross‑functional teams with medical expertise, as needed. Provide consultation, training, and education to staff and community partners on relevant topics as needed. Train and mentor peers within the Medical Management team and assist with onboarding new PH Medical Directors as needed. Work with Human Resources and the Medical Team to attract, maintain, and retain a highly qualified and well‑trained workforce. Actively establish and promote a positive, diverse, and inclusive working environment that builds trust among teammates. Ensure all staff are treated with respect and dignity. Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members. Minimum Requirements Graduation from an accredited Medical School; M.D./D.O. degree required. Board certification in a relevant field. At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience. Current, active, and unrestricted license to practice medicine in North Carolina (or qualifications to obtain a North Carolina Medical License with board certification for an appropriate field of medicine). Knowledge of diagnosis, treatment of medical issues, recent developments in the field of medicine, and managed care principles. Microsoft Office skills and ability to speak with colleagues about treatment concerns, complex case issues, and best‑practice recommendations. Utilization management experience. Salary & Benefits Salary Range: $211,172 – $269,245 Annually (exact compensation based on education, experience, and market data). Benefits include: Medical, Dental, Vision, Life, Long‑Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off (vacation, sick leave, holiday, management leave) Dress flexibility Supervisor – Transition to Community Living (TCL) Care Management Full‑time hybrid opportunity focused on supervising TCL Care Managers who support members utilizing behavioral and physical health services within the Alliance Health Plan. Supervisory duties include ensuring adherence to the permanent supportive housing model, coordinating services for whole‑person health, and fostering a positive workplace environment. Responsibilities & Duties Supervise and develop staff, working with Human Resources and the Unit Director to retain a well‑trained workforce. Ensure staff training and compliance with all organization and department policies, procedures, business processes, and workflows. Provide tools and resources to achieve organizational goals and support employee compliance with licensure, regulatory, and accreditation requirements. Foster a diverse, inclusive, and respectful work environment. Set performance goals and deadlines aligned with organizational vision. Communicate feedback, coach, and mentor staff to advance professional development. Encourage cross‑team collaboration and partnership. Ensure adherence to contractual obligations and benchmarks. Maintain documentation standards in electronic medical records for comprehensive assessments, care plans, and quality of UM submissions. Track TCL data across platforms to meet state requirements. Provide oversight of complex cases, including escalation, referrals to physical or behavioral health consultants, and community health workers. Ensure compliance with agency and departmental policies, facilitating smooth care management operations. Participate in local, regional, and state meetings as required. Implement and improve policies and procedures for the Tailored Plan/Medicaid Direct system, including DOJ settlement implementation. Analyze community capacity for service needs, gaps, and best‑practice implementation. Oversee implementation of system‑wide quality and accessibility enhancements for high‑risk citizens. Partner with stakeholders to assess opportunities, barriers, and deliver coordinated services. Maintain relationships with providers, community agencies, and other stakeholders. Collaborate with alliance departments to meet consumer and agency goals. Monitor staff compliance with policies and procedures. Improve department procedures and increase operational efficiency. Ensure completion of TCL monitoring and quality of life surveys. Support TCL Care Managers in securing required documentation for tenancy and rehousing processes. Provide technical assistance to providers during housing and rehousing processes. Assist with documentation during discharge and transitions between housing programs. Travel between alliance offices, attend meetings, and serve as a liaison to members, providers, and stakeholders. Minimum Requirements Master’s degree in an accredited Human Service field. Three (3) years of post‑degree experience in care management, case management, or care coordination for complex individuals with I/DD or TBI. Full or provisional license in North Carolina (or eligibility to obtain one). Strong knowledge of regulatory requirements and emerging trends in utilization management and physical health services. Provider Network Evaluator I (PNE I) – Home and Community Based Services (HCBS) Full‑time remote position with travel across Mecklenburg County and surrounding areas to conduct on‑site reviews and monitoring. Must reside in North Carolina. Responsibilities & Duties Validate and approve TBI, Innovation Waiver, 1915(i), and LTCS sites and services; review documentation for compliance and authorize member access. Perform HCBS reviews on time and maintain portal entries for service initiation and move‑in. Review provider policies and procedures for CMS mandated HCBS standards compliance. Collaborate with other MCOs when members transfer into or out of the Alliance catchment area. Assist providers in remediating out‑of‑compliance findings through technical assistance or corrective plans. Coordinate with I/DD Care Coordination and agency providers to ensure site validation and compliance. Remediate issues identified by the state through MIE surveys, documentation review, and stakeholder collaboration. Provide reports and updates on HCBS review outcomes to the Provider Network Evaluator Supervisor or Director of Network Evaluation. Review self‑directed services (Employer of Record) annually, ensuring compliance with CCP8‑P, Attachment H and other mandates. Assist in maintaining the HCBS database, including new sites and site discontinuations, and reconcile state required reports. Track I/DD Care Coordination HCBS assessments and communicate discrepancies. Maintain knowledge of current services and supports available within the catchment area. Participate in investigations and focused reviews when concerns about quality of care or safety arise. Travel to review sites, meet with members, providers, and stakeholders, and attend court hearings as required. Minimum Requirements Bachelor’s degree in a Human Service field (e.g., Psychology, Social Work). Minimum five (5) years of progressive experience in I/DD or TBI services. Strong knowledge of I/DD and TBI services and HCBS experience highly desired. Valid driver's license with a good driving record; ability to maintain one in a foreign state if necessary. Knowledge of federal and state statutes regulating MHDDSAS services. Understanding of mental health, developmental disabilities, and substance abuse services. Diplomacy, mediation, team building, communication, and Microsoft Office skills. Analytical skills for administrative problem‑solving. Independent judgment, logical reasoning, and decision‑making. Discretion, confidentiality, and crisis handling abilities. Data analysis and program evaluation skills. Salary Range Hourly: $25.75 – $32.83 ( exact compensation based on education, experience, and market data ) Benefits include: Medical, Dental, Vision, Life, Long‑Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off (vacation, sick leave, holiday, management leave) Dress flexibility #J-18808-Ljbffr SC Works Trident