Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
💰 $135M Series C on 2020-03
Healthcare Insurance • Insurance • Healthcare
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
Medical Director – Utilization Management
🕒 May 20
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Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
💰 $135M Series C on 2020-03
Healthcare Insurance • Insurance • Healthcare
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
📋 Description
• 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
• 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
• Health insurance • 401(k) • Paid time off
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