FirstHealth of the Carolinas
Physician - Medical Director - Utilization Management
FirstHealth of the Carolinas, Pinehurst, North Carolina, United States, 28374
Utilization Management Leader
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
About the Opportunity: 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. Enjoy a comprehensive compensation and benefits package: Guaranteed base salary Health, life, and disability coverage 3 retirement savings plans 401a, 403b with match, 457b Paid time off benefits CME allowance, license, and DEA reimbursement Customized wellbeing resources Free fitness center membership Paid parental leave Paid malpractice with tail coverage About FirstHealth of the Carolinas: Financially stable organization with four hospitals, facilities for inpatient/outpatient rehabilitation, hospice, a palliative care program, home care, community outreach programs, integrated neurosciences, health & fitness centers, primary care, functional & concierge medicine, convenient care clinics, a hospitality house, EMS, a philanthropic foundation, and more. Here you will find specialty and subspecialty services and technologies that rival those typically only found in academic institutions and in larger metropolitan areas. Recent awards and achievements: Ranked #5 in NC on U.S. News & World Report's list of Best Hospitals for 2025. Recognized by the American Heart Association for excellence in stroke and heart failure care. 2025 Outstanding Patient Experience Award recipient by Healthgrades our 18th consecutive year! On the Forbes list of America's Best Large Employers for 2025 One of the Top 150 Places to Work in Health Care by Becker's Healthcare 3 years running! Be part of our mission-driven teamon a journey to zero harm and to be the best place to work in healthcare. About Pinehurst: Located in the heart of North Carolina, Pinehurst offers a blend of Southern charm, outdoor recreation, and upscale amenities. Home to over 40 golf courses and host to multiple U.S. Open Championships. Convenient location: 1 hour from Raleigh-Durham, 2 hours from Charlotte, and 3 hours to the beach or mountains. Strong, diverse economy supported by tourism, healthcare, small manufacturing, education, and entrepreneurship. Exceptional quality of life with a temperate four-season climate and access to both rural tranquility and urban convenience. Consistently ranked among North Carolina's safest communities and top micropolitan areas by POLICOM. Neighboring Southern Pines offers premier equestrian facilities, training centers, and boarding stables. Qualifications
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. ** Sorry, NO visa sponsorship available ** For more information and to apply, please contact our in-house Physician Recruitment team at FHPG-Recruitment@.
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
About the Opportunity: 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. Enjoy a comprehensive compensation and benefits package: Guaranteed base salary Health, life, and disability coverage 3 retirement savings plans 401a, 403b with match, 457b Paid time off benefits CME allowance, license, and DEA reimbursement Customized wellbeing resources Free fitness center membership Paid parental leave Paid malpractice with tail coverage About FirstHealth of the Carolinas: Financially stable organization with four hospitals, facilities for inpatient/outpatient rehabilitation, hospice, a palliative care program, home care, community outreach programs, integrated neurosciences, health & fitness centers, primary care, functional & concierge medicine, convenient care clinics, a hospitality house, EMS, a philanthropic foundation, and more. Here you will find specialty and subspecialty services and technologies that rival those typically only found in academic institutions and in larger metropolitan areas. Recent awards and achievements: Ranked #5 in NC on U.S. News & World Report's list of Best Hospitals for 2025. Recognized by the American Heart Association for excellence in stroke and heart failure care. 2025 Outstanding Patient Experience Award recipient by Healthgrades our 18th consecutive year! On the Forbes list of America's Best Large Employers for 2025 One of the Top 150 Places to Work in Health Care by Becker's Healthcare 3 years running! Be part of our mission-driven teamon a journey to zero harm and to be the best place to work in healthcare. About Pinehurst: Located in the heart of North Carolina, Pinehurst offers a blend of Southern charm, outdoor recreation, and upscale amenities. Home to over 40 golf courses and host to multiple U.S. Open Championships. Convenient location: 1 hour from Raleigh-Durham, 2 hours from Charlotte, and 3 hours to the beach or mountains. Strong, diverse economy supported by tourism, healthcare, small manufacturing, education, and entrepreneurship. Exceptional quality of life with a temperate four-season climate and access to both rural tranquility and urban convenience. Consistently ranked among North Carolina's safest communities and top micropolitan areas by POLICOM. Neighboring Southern Pines offers premier equestrian facilities, training centers, and boarding stables. Qualifications
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. ** Sorry, NO visa sponsorship available ** For more information and to apply, please contact our in-house Physician Recruitment team at FHPG-Recruitment@.