Physician - Medical Director - Utilization Management at FirstHealth of the Carolinas in US-NC-Pinehurst

Job description

• Unique opportunity to make a measurable impact on healthcare delivery and quality!
• Dynamic physician leader needed to champion FirstHealth’s Utilization Management efforts. We are a private, community-based healthcare system with four hospitals serving 15 counties in the mid-Carolinas. Our organizational culture is guided by a commitment to patient safety, quality, and performance excellence.

Responsibilities

• On-site position based at our flagship campus in Pinehurst, NC.
• Serve as the clinical expert on physician practice patterns, over- and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding, and documentation requirements.
• Work closely with medical staff leadership, all medical staff, and ancillary departments to optimize services and ensure appropriateness of patient care.
• Collaborate with hospital leadership to develop care management protocols that drive improvements and effectively manage resources.
• Guaranteed base salary
• Health, life, and disability coverage
• 3 retirement savings plans – 401a, 403b with match , 457b
• Paid time off benefits plus Paid Parental Leave
• CME allowance, license, and DEA reimbursement
• Customized wellbeing resources
• Free fitness center membership
• Paid malpractice with tail coverage

Requirements

• MD or DO degree.
• Current CHCQM-PHYADV certification, or ability to obtain within 90 days of employment.
• Current ABMS or AOA board certification.
• Active, unrestricted NC medical license.
• 5+ years of post-residency clinical practice experience PLUS at least one year of prior UM experience.
• Demonstrated leadership skills and the ability to influence others.
• Thorough understanding of current CMS and DNV compliance requirements
• Robust knowledge of hospital coding and billing, payer contracting, and revenue cycle management.
• Effective collaboration with physician peers, administration, and support staff.
• Advanced proficiency with EMRs and utilization review tools.

Skills

Required

• Leadership
• Influence
• Collaboration
• EMR proficiency
• Utilization review tools
• CMS and DNV compliance
• Hospital coding and billing
• Payer contracting
• Revenue cycle management