Seeking a Medical Director of Utilization Management Full Time: 40 hrs/wk Mon-Fri 8A-5P 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 CME allowance, license, and DEA reimbursement Customized wellbeing resources Free fitness center membership Paid Parental Leave Paid malpractice with tail coverage Required: Current CHCQM-PHYADV certification, or ability to obtain within 90 days of employment, Board Certification, Active, unrestricted NC medical license. 5+ years of post-residency clinical practice experience PLUS at least one year of prior UM experience. 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.
