In this full-time inpatient role, the physician advisor reviews medical necessity, level of care, documentation, and utilization decisions for hospitalized patients, including observation cases and payer-facing reviews. The work centers on denial management, peer-to-peer appeals, and helping ensure clinical documentation supports the care provided and meets regulatory requirements. The role also partners with care management, utilization review, revenue cycle, and hospital leadership, with rotating weekend call coverage.
Key Responsibilities
- Conduct level of care reviews, including initial determinations, secondary review, and observation cases.
- Provide documentation improvement recommendations to support medical necessity, severity of illness, and care progression.
- Participate in denials management, including peer-to-peer appeals and appeal letter drafting.
- Use InterQual, MCG, and other criteria to support utilization review decisions.
- Apply Medicare utilization rules, including the 2-midnight rule, to review cases.
- Coordinate with case management, utilization review, providers, and hospital leadership on utilization and length-of-stay goals.
- Educate and mentor physicians and case management staff on documentation and payer requirements.
- Recommend additional chart documentation to support placement status, billing, and reimbursement.
Required
- MD or DO degree.
- Unrestricted medical license in the State of Illinois.
- At least 5 years of clinical experience in a hospital setting.
- Experience or a strong foundation in utilization management and hospital operations.
Preferred
- Palliative care fellowship training.
- ABQAURP certification.
- HCQM certification.
- American College of Physician Advisors certification (ACPA-C).
Benefits & Perks
- Full-time inpatient leadership role.
- Rotating weekend call coverage.
- Opportunity to work closely with hospital leadership and multidisciplinary teams.
- Pay range of $95.38 - $141.06 per hour.