Job DescriptionJob SummaryThe Physician Advisor provides clinical expertise and guidance to support case management, utilization review, and quality improvement initiatives across the organization. This role works closely with medical staff, case management, and other healthcare professionals to optimize patient care, ensure adherence to best practices, and support efficient resource utilization. The Physician Advisor also assists in compliance with regulatory standards and internal policies related to patient care and documentation.
Essential Functions - Reviews patient cases and collaborates with case management and clinical teams to promote efficient, quality patient care aligned with medical necessity and best practices.
- Provides guidance on regulatory requirements and payer guidelines to ensure accurate documentation and compliance with utilization review and admission criteria.
- Assists in the development and implementation of strategies to improve clinical outcomes, streamline patient flow, and reduce length of stay.
- Advises on appropriate utilization of resources, ensuring treatments and services meet evidence-based guidelines and regulatory standards.
- Serves as a clinical resource for healthcare providers, offering insights on medical necessity, levels of care, and length of stay determinations.
- Participates in quality improvement initiatives and performance metrics monitoring to identify trends and recommend process improvements.
- Communicates effectively with physicians and hospital staff regarding case management practices, payer guidelines, and utilization review protocols.
- Performs other duties as assigned.
- Complies with all policies and standards.
Qualifications - Doctor of Medicine (MD) required or
- Doctor of Osteopathy (DO) required
- 2-4 years of clinical experience in an acute care setting or relevant healthcare environment required
- 2-4 years of experience in utilization management, case management, or quality improvement preferred
Knowledge, Skills and Abilities - Strong understanding of healthcare regulations, utilization management, and documentation standards.
- Excellent communication and interpersonal skills to work collaboratively with diverse healthcare teams.
- Knowledge of evidence-based guidelines and payer-specific admission criteria.
- Analytical and problem-solving skills to evaluate clinical cases and make recommendations.
- Ability to provide guidance and education on medical necessity, quality measures, and compliance requirements.
- Familiarity with electronic health record (EHR) systems and case management software.
Licenses and Certifications - MD - Physician - State Licensure required or
- DO - Doctor of Osteopathy required
- Board certification in a medical specialty through the American Board of Medical Specialties (ABMS) required
- Board certified with internal medicine, family medicine or emergency medicine preferred
