The Physician Advisor reviews patient cases to support appropriate level-of-care decisions, utilization management, documentation accuracy, and compliance across hospitalized patients. This role partners closely with hospital physicians, case management, CDI, quality teams, and payors on status reviews, continued stay reviews, denial appeals, and medical necessity discussions. It is an experienced, hospital-based physician leadership position with a strong focus on consultative review and education.
Key Responsibilities
- Conduct medical record reviews for cases identified by utilization management or the care team.
- Provide status determinations, second-level reviews, continued stay reviews, and Code 44 reviews.
- Coordinate with case management and the interdisciplinary team to support continuity of care and reduce readmissions.
- Communicate with hospital physicians and medical staff through email, texting, phone, and in-person discussions.
- Act as a liaison between utilization management, case management, and providers to support appropriate plans of care.
- Review denials and author appeal letters as needed.
- Perform peer-to-peer discussions with payors and support approval of appropriate levels of care.
- Provide education on utilization, medical necessity, compliance, and resource use to hospital personnel.
Required
- MD or DO degree.
- Current unrestricted medical license in the state of residence.
- 1-3 years of Physician Advisor experience.
- Clinical experience in a hospital-based setting.
- Strong computer skills and working knowledge of EMRs.
- Ability to build rapport with medical staff and hospital leadership.
Preferred
- Experience in utilization management.
- Board certified or board eligible.
- CCDS, CDIP, or CCS certification.
- CHCQM certification.
Benefits & Perks
- 7 on / 7 off schedule.
- Office-based working conditions with standard computer-focused work.
- Opportunity to work across hospital quality, utilization, and denial management workflows.