Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
👥 B2C
💰 $321.1M Post-IPO Debt - Alignment Health on 2024-11
Healthcare Insurance • B2C
Alignment Health is a Medicare-focused health insurance company that offers Medicare Advantage plans and member-centered services. It provides 24/7 on-demand access to care via in-person, in-home, and mobile channels and features a concierge-style on-demand card to help members schedule appointments, arrange transportation, and answer health questions. Alignment Health partners with brokers, providers, Accountable Care Organizations (ACOs), and institutional partners, operates in multiple U. S. states (including Arizona, California, Nevada, North Carolina, and Texas), and has earned high CMS ratings and industry recognition.
Physician Advisor, Utilization Management, CA License Required
🕒 May 26
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Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
👥 B2C
💰 $321.1M Post-IPO Debt - Alignment Health on 2024-11
Healthcare Insurance • B2C
Alignment Health is a Medicare-focused health insurance company that offers Medicare Advantage plans and member-centered services. It provides 24/7 on-demand access to care via in-person, in-home, and mobile channels and features a concierge-style on-demand card to help members schedule appointments, arrange transportation, and answer health questions. Alignment Health partners with brokers, providers, Accountable Care Organizations (ACOs), and institutional partners, operates in multiple U. S. states (including Arizona, California, Nevada, North Carolina, and Texas), and has earned high CMS ratings and industry recognition.
📋 Description
• Works with Senior Medical Officers, Regional Medical Officers, Extensivists, and the Healthcare Services Team to optimize use of Institutional and Outpatient services. • Completes clinical reviews for medical necessity, treatment appropriateness, and compliance. • Provides appropriate level of care classifications and continued stay reviews in compliance with CMS and Milliman guidelines. • Acts as liaison between medical staff, utilization review, and 3rd party payers to promote appropriate levels of medical care. • Reviews the entire claim denial process, including Appeals and Grievances. • Serves as a Physician member of the utilization review team.
🎯 Requirements
• 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 required (preferably in internal medicine). • Current, non-restricted licensure as required for clinical practice in the state of California.
🏖️ Benefits
• Health insurance • Retirement plans
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