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.

• 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.

• 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.