Dir-Utilization Management-Physical Health; Remote, Morrisville, NC

Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)

• Posted on June 25, 2026
• Remote
• Full-Time
• Requisition #: DIRUT
  003426

Locations:
Home Office, 5200 W. Paramount Parkway Ste 200, Morrisville, NC 27560, USA.

The Director of Utilization Management (UM) for Physical Health is responsible for administering and coordinating physical health utilization management activities for Alliance. This position ensures the UM Department operates as an integrated department providing a holistic review of member’s needs. The position is responsible for overseeing a core component that ensures that individuals receive the correct level and intensity of services that results in positive outcomes.

This job also develops systems to monitor the appropriate utilization of both state and Medicaid funds.

This position is full‑time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.

Develop and implement Unit goals and objectives

• Integrate the department and its functions into the organization’s primary mission.
• Ensure the Utilization Management Department serves as an integrated department through effectively collaborating with the Director of Behavioral Health Utilization Management and the Sr. Director of Utilization Management

• Work with Human Resources and the Sr. Director of UM to maintain and retain a highly qualified and well-trained workforce.
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes.
• Organize workflows and ensure staff understand their roles and responsibilities.
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements.
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust.
• 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.
• Work to resolve conflicts and disputes, ensuring that all participants are given a voice.
• Set goals for performance and deadlines in line with organization goals and vision.
• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development.
• Cultivate and encourage efforts to expand cross‑team collaboration and partnership.
• Effectively utilize and teach to the team how to effectively utilize authorization, claims and per diem data in order to remain within Alliance’s Cost of Care plan
• Supervise UM Physical Health employees to assure accountability and productivity in meeting Department objectives and targets.
• Oversee delegated vendors performing utilization reviews for physical health services.
• Monitor UM vendors for compliance with delegation agreements and corrective action plans.
• Report analysis of non‑compliance when identified.

• Ensure consistent application of medical necessity criteria for physical health services.
• Participate in the development and implementation of department policies and procedures
• Ensure compliance with performance measures outlined within NC DHB, NC DMH contracts and all accrediting body standards.
• Protect client rights by ensuring all UM staff are trained and follow due process procedures, including the timely processing of treatment requests.
• Implement a system to maintain and assure that the authorization of services provided by clinical care staff appropriately address the service needs, types of service, outcomes, and alternatives available to consumers.
• Refine and evaluate the methods of authorization for services and treatment; develop strategies for accessing alternative to care.
• Provide education to hospitals, nursing homes and other care providers concerning departmental procedures and requirements for approving length of stay extensions.
• An…