This physician leadership role oversees utilization management, clinical documentation integrity, denials and appeals, and revenue integrity across the health system. The clinician provides medical necessity review, guides reimbursement and documentation practices, and helps reduce regulatory and financial risk through system-wide standards and physician education. The role works closely with care management, revenue cycle, payer strategy, and medical staff leaders to align workflows and improve performance.
Key Responsibilities
- Establish and lead system-wide strategy and operating standards for physician advisor services.
- Provide oversight for utilization management, clinical documentation integrity, denials/appeals, and revenue integrity workflows.
- Conduct medical necessity reviews and support compliant reimbursement decisions.
- Coordinate with care management, revenue cycle, HIM/coding, and payer strategy leaders to align priorities and processes.
- Drive standard work, escalation pathways, and performance expectations across sites and service lines.
- Use data-informed insights to influence physician practice patterns and improve documentation quality.
- Participate in physician education, peer leadership, and issue escalation to reduce denial and compliance risk.
Required
- MD or DO from an accredited U.S. medical school or equivalent.
- Unrestricted medical license in Oregon and Washington.
- Board certification in a clinical specialty.
- At least 7 years of clinical practice and/or physician leadership experience.
- Strong knowledge of utilization management, medical necessity, denials/appeals, and clinical documentation integrity.
Preferred
- 3 years of physician leadership, medical director, or UM/CDI/revenue cycle advisory experience.
- Experience with healthcare finance, revenue cycle operations, and regulatory compliance.
- American College of Physician Advisors certification or equivalent credential.
- ABQAURP, Certified Healthcare Quality and Management, or similar quality/utilization certification.
Benefits & Perks
- System-wide physician leadership role with organizational impact.
- Collaborative work with executive and operational leaders across multiple departments.
- Opportunity to shape standards, workflows, and performance across the health system.
- Employee benefits information is referenced in the posting.