Physician Advisor who reviews inpatient and post-acute utilization, medical necessity, and level-of-care decisions while advising case management, utilization management, and hospital leadership. The role also supports documentation, coding, denial management, length-of-stay management, and readmission reduction across the hospital system. This is a physician leadership position with substantial education, committee participation, and collaboration with clinicians, revenue cycle, and IT teams.
Key Responsibilities
- Conduct medical necessity reviews, including initial level of care, secondary reviews, and continued stay reviews.
- Provide peer-to-peer support for inpatient and post-acute care denials and help prevent avoidable denials.
- Advise case management, utilization management, nurses, and physicians on complex clinical and status-related issues.
- Coordinate with physicians, hospital administration, and payers to support appropriate placement, approvals, and length-of-stay management.
- Review medical records and request additional documentation to support medical necessity, coding, and placement status.
- Provide education to physicians and clinicians on utilization management, regulatory requirements, documentation, and alternative levels of care.
- Participate in quality, utilization review, revenue cycle, risk management, and performance committees.
- Collaborate with IT leadership on order sets, practice guidelines, and physician training to improve workflow and utilization.
Required
- Doctoral degree in Medicine (MD or DO).
- Unrestricted medical license in the state of Michigan.
- Board certification.
- At least 5 years of clinical practice experience.
- Membership eligibility in the Henry Ford Medical Staff.
- Working knowledge of utilization management, quality improvement, patient safety, and EMRs.
Preferred
- Experience with MCG/InterQual criteria.
- Board certification from ABQAURP or ACPA-C.
- Experience in physician advisory, utilization review, or case management operations.
- EPIC experience preferred.
Benefits & Perks
- Physician leadership role with direct impact on utilization, quality, and revenue cycle processes.
- Opportunities to teach and mentor physicians and care teams.
- Participation in hospital committees and systemwide quality improvement efforts.
- Collaboration with a multidisciplinary team across medical staff, case management, IT, and administration.
- Ongoing training and continuing education related to utilization and quality management.