Physician - Medical Director - Utilization Management

Job description

Overview
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.
Position Highlights
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 plus Paid Parental Leave
• CME allowance, license, and DEA reimbursement
• Customized wellbeing resources
• Free fitness center membership
• 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:
• 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!
• One of the Top 150 Places to Work in Health Care by Becker’s Healthcare – 3 years running!
• Be part of our mission-driven team—on 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 [email protected] .