Medical Director

• Responsible for utilization review case management for North Carolina Medicaid
• Develop and implement programs to improve quality, cost, and outcomes
• Provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
• Identify cost of care opportunities
• Serve as a resource to staff including Medical Director Associates
• Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
• Conduct peer-to-peer clinical appeal case reviews
• Interpret medical policies and clinical guidelines
• Develop and propose new medical policies based on changes in healthcare
• Lead, develop, direct, and implement clinical and non-clinical activities that impact health care quality cost and outcomes

Utilization Management Medical Director

Medical Director – Addiction Physician

Part-time Medical Director