About this role
The Physician Advisor serves as a physician leader and strategic partner to hospital administration, medical staff, case management, utilization management, clinical documentation integrity (CDI), health information management (HIM), and revenue cycle teams. This non-clinical leadership role supports the delivery of medically necessary, high-quality, and efficient patient care while advancing organizational goals related to patient throughput, length of stay, documentation integrity, denial prevention, regulatory compliance, and physician engagement.
The Physician Advisor collaborates closely with physicians, nursing leadership, case management, CDI, HIM, and executive leadership to improve clinical, operational, quality, and financial outcomes across the organization.
Perform secondary physician reviews and medical necessity determinations. Conduct peer-to-peer discussions with payer medical directors. Support denial prevention, appeal, and overturn activities. Collaborate with case management and utilization management teams regarding level-of-care determinations. Provide physician leadership and support for utilization management initiatives and committees. Participate in multidisciplinary rounds, eTEMPO, and patient throughput activities. Support observation management and length-of-stay optimization initiatives. Partner with CDI and HIM teams to improve documentation quality, accuracy, and compliance. Conduct one-on-one physician education and coaching based on identifying outlier performance through our data platforms. Serve as a liaison between medical staff and hospital leadership.
Education
Required: Doctor of Medicine Degree (M.D.) or Doctor of Osteopathic Medicine Degree (D.O.).
Experience
Required: Active or recent hospital-based clinical practice experience.
Preferred: Prior Physician Advisor experience. Utilization Management experience. CDI or Case Management experience. Medical Staff leadership experience. Experience with MCG and/or InterQual criteria. Familiarity with Medicare Advantage, Medicaid, and Commercial payer processes.
Certifications
Required: Active unrestricted medical license. Board certification by an ABMS-recognized specialty board.
Physical Demands: