Physician Advisor Lead

The Physician Advisor Lead provides clinical leadership, mentorship, quality oversight, and operational support to the company’s Physician Advisor team while maintaining an active production workload. Serving as a senior Physician Advisor and clinical subject matter expert, this role promotes consistent clinical decision-making, effective payer-to-provider communication, and high-quality utilization management outcomes across the company client engagements.

The Physician Advisor Lead partners with the company leadership, Physician Advisors, Utilization Review teams, and clients to improve medical necessity determinations, peer-to-peer (P2P) performance, denial prevention, and overall utilization management outcomes.

Key Responsibilities

• Provide clinical leadership, mentorship, and day-to-day support to the company Physician Advisors.

• Maintain an active production workload and perform Physician Advisor duties on assigned client accounts.

• Serve as a senior clinical resource for complex, high-priority, and escalated utilization review, medical necessity, and P2P cases.

• Establish and promote consistent clinical, documentation, communication, and client-service standards.

• Conduct and oversee regular Physician Advisor quality and call audits.

• Monitor key performance indicators, including P2P completion, callback responsiveness, overturn rates, quality, timeliness, and client service.

• Identify performance trends and opportunities for coaching, education, and process improvement.

• Partner with HR and Operations on performance reporting, management, and improvement initiatives.

• Support Physician Advisor onboarding, training, and ongoing professional development.

• Develop and maintain educational resources, reference materials, and standardized best practices for P2P preparation, documentation, escalation, follow-up, and payer communication.

• Serve as a senior clinical resource for clients regarding escalated clinical and operational issues.

• Participate in client meetings, operational reviews, and clinical discussions as needed.

• Identify trends in denials, medical necessity determinations, payer behavior, and utilization management practices that affect client outcomes.

• Collaborate with the company leadership to develop clinical recommendations, improve workflows, and expand Physician Advisor services, SME offerings, and specialized clinical programs.

• Support the ongoing development and standardization of the company’s Physician Advisor program.

Qualifications

• Active, unrestricted U.S. physician license.

• Board certification in an appropriate specialty.

• Significant Physician Advisor experience, including the ability to maintain an active production workload.

• Strong background in utilization management, hospital medicine, healthcare revenue cycle, or a related clinical setting.

• Demonstrated expertise in P2P reviews, medical necessity determinations, inpatient admission criteria, continued stay reviews, denials, appeals, and payer processes.

• Experience managing complex clinical cases and conducting payer-to-provider negotiations.

• Strong written and verbal communication, negotiation, and collaboration skills.

• Experience mentoring, coaching, or leading physicians preferred.

• Experience with Epic or other major EHR platforms preferred.

• Ability to work effectively in a remote, client-facing environment while meeting clinical leadership, production, quality, timeliness, and client-service expectations.

• Travel as needed.