Current CHCQM-PHYADV certification, or ability to obtain within 90 days
Current ABMS or AOA board certification
Active, unrestricted NC medical license
5+ years of post-residency clinical practice experience with at least one year in Utilization Management
Demonstrated leadership skills
Thorough understanding of CMS and DNV compliance requirements
Responsibilities
Serve as clinical expert on physician practice patterns and resource utilization
Collaborate with medical staff leadership and departments to optimize patient services
Develop care management protocols with hospital leadership
Oversee compliance with medical necessity and documentation standards
Influence and educate physician peers on best practices in care progression
Lead initiatives to improve patient care quality and safety
Benefits
Guaranteed base salary
Health, life, and disability coverage
Three retirement savings plans with match
Paid time off benefits
CME allowance, license, and DEA reimbursement
Free fitness center membership
Paid parental leave
Paid malpractice with tail coverage
Full Job Description
Overview
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 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@firsthealth.org.
About First Health Of The Carolinas
FirstHealth of the Carolinas is a private, non-governmental, not-for-profit health care network serving the mid-Carolinas. Its core purpose is to provide quality health care services, promote health and wellness, educate patients and the community, and support research. The network includes four hospitals, primary and convenient care clinics, dental centers, home health, hospice and palliative care services, and a variety of other services.
