Physician Advisor

***WE ARE CURRENTLY FULLY STAFFED, BUT OUR NEEDS CAN CHANGE AT ANY TIME,

AND WE ARE STILL ACCEPTING APPLICATIONS***

The Physician Advisor provides physician-to-physician reviews, clinical guidance, education, and escalation support while promoting evidence-based practices and appropriate resource utilization.

Key Responsibilities

• Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals

• Support utilization review and case management teams with complex clinical decision-making

• Ensure appropriate admission status determinations (inpatient vs. observation) in alignment with CMS and payer guidelines

• Provide clinical oversight related to length of stay, care progression, and discharge planning

• Ensure adherence to CMS Conditions of Participation, Medicare regulations, and payer policies

• Support compliance with medical necessity criteria (InterQual, MCG, or equivalent)

• Assist with audit preparedness and response, including RAC, MAC, and commercial payer audits

• Partner with HIM/CDI teams to improve documentation quality and clinical accuracy

Education & Physician Engagement

• Serve as a trusted peer resource to attending physicians and advanced practice providers

• Educate medical staff on regulatory requirements, utilization best practices, and documentation standards

• Support change management initiatives related to clinical operations and compliance

Qualifications

Required

• MD or DO with an active, unrestricted medical license

• Board-certified or board-eligible in a recognized specialty

• Clinical practice experience in an acute care or relevant healthcare setting

• Strong knowledge of utilization management, medical necessity, and payer regulations

• Excellent communication skills with the ability to conduct peer-to-peer discussions

Preferred

• Prior experience as a Physician Advisor, Medical Director, or in Utilization Review

• Familiarity with CMS guidelines, InterQual, MCG, and denial management processes

• Experience working with case management, CDI, HIM, or revenue cycle teams

• Experience in a remote or consulting healthcare environment

Skills & Competencies

• Physician-to-physician negotiation and collaboration

• Clinical judgment balanced with regulatory and financial awareness

• Data-driven decision-making

• Ability to influence without authority

• Strong written and verbal communication