Schedule: Full time
Shift: Day (United States of America)
Address: 2100 OCOEE APOPKA RD
City: APOPKA
State: Florida
Postal Code: 32703
Job Description:The Physician Advisor educates and advises Utilization Management, HIM, Revenue Cycle, Patient Access, Managed Care teams, and medical staff on updates and trends related to utilization and denial prevention. The role provides physician-level review of utilization, claims management, and quality assurance for inpatient, outpatient/observation, and referral services. It supports Chief Medical Officer functions across the region to ensure high-quality, efficient care throughout the continuum and serves as a key contact for clinicians, payers, external providers, and regulatory entities. The Physician Advisor acts as a subject matter expert, offering clinical and business guidance to promote high-quality, patient-focused, cost-effective care while maintaining respectful, collaborative relationships.
- Reviews and authorizes inpatient days, evaluates utilization patterns, and ensures appropriate inpatient/outpatient determinations.
- Works closely with Utilization Management staff on process improvement, case reviews, and continuity of care efforts.
- Serves as a clinical liaison with attending physicians and medical staff to support decision-making and accurate documentation.
- Collaborates with managed care payers and their medical directors on denials, appeals, and utilization criteria.
- Analyzes data and trends to identify utilization improvement opportunities, develop benchmarking, and monitor outliers.
- Provides education to physicians and clinical teams on UM protocols, regulatory changes, and documentation requirements.
- Reviews concurrent and post-acute payer denials, intervenes with providers and payers, and supports denial prevention strategies.
- Participates in Utilization Management and hospital committees, sharing trends and supporting quality and operational initiatives.
- Supports organizational goals related to length of stay, quality, responsible resource stewardship, and overall performance.
- Performs other duties as assigned.
Knowledge, Skills, and Abilities: - Strong ability to build and sustain relationships in the medical community and a corporate environment [Required]
- Successful history as a practicing physician [Required]
- Strong organization skills with attention to detail [Required]
- Excellent analytical and problem-solving skills [Required]
- Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff [Required]
- Ability to work in a matrix-management environment to achieve organizational goals [Required]
- Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike [Required]
- Ability to provide expert medical advice and explain complex medical situation [Required]
- Health plan experience in operations [Preferred]
- Experience in a physician group model, leadership experience [Preferred]
- Effective computer skills, particularly Microsoft Office Outlook, Word, Excel, PowerPoint [Preferred]
Education: - Doctorate [Required]
- Master's [Preferred]
Field of Study: - Graduate of an accredited Medical School
- in Business or Healthcare Administration
Work Experience: - 5+ years recent clinical practice experience [Required]
- 2+ years or greater experience as a Physician Advisor [Preferred]
- 3+ years of leadership experience [Preferred]
Licenses and Certifications: - Medical Doctor (MD) [Required] OR Doctor of Osteopathic Medicine (DO) [Required]
- Basic Life Support (BLS) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
- Physical Requirements - https://tinyurl.com/23km2677
Pay Range:$206,606.17 - $413,212.34
