Pennsylvania Medicine

Physician Advisor - Corporate

Pennsylvania Medicine$210K — $250K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • PA State Licensed Medical Doctor or Doctor of Osteopathic Medicine (Required)
  • Minimum of 5 years clinical experience in a hospital setting
  • At least 3 years of experience with information technology, statistical analysis, and medical informatics
  • In-depth understanding of utilization management and hospital operations
  • Strong knowledge of electronic medical records and clinical protocols

Responsibilities

  • Provide clinical oversight on admission status and medical necessity determinations
  • Conduct secondary reviews and assist in resolving complex cases
  • Engage in peer-to-peer discussions focused on denial prevention
  • Educate medical staff on documentation standards and utilization practices
  • Collaborate with interdisciplinary teams to enhance patient flow and reimbursement accuracy
  • Identify trends in denials and utilization patterns for improvement initiatives
  • Participate in projects and initiatives aligned with organizational values

Benefits

  • Comprehensive health and wellness programs
  • Prepaid tuition assistance for employees
  • Engagement in a mission-driven environment
  • Opportunities for professional development
  • Supportive community dedicated to making medical advancements
Full Job Description
Entity: Corporate Services

Department: Corp Utilization Management

Location: HUP/ hybrid

Summary:

The Physician Advisor serves as a key clinical leader within Utilization Management (UM), reporting to the AVP of Utilization Management and working in close partnership with the Lead to support appropriate patient status determinations, medical necessity review, and regulatory compliance. This role provides timely clinical consultation to UM, Case Management, and medical staff to promote accurate level-of-care decisions and effective use of healthcare resources.

In collaboration with the Lead and interdisciplinary partners, the Physician Advisor supports physician education, case escalation, documentation improvement, and denial prevention efforts across the continuum of care. Through case review, peer-to-peer engagement, and alignment with organizational and payer requirements, this role contributes to efficient care progression, improved patient outcomes, and strong operational and financial performance.

Responsibilities:
  • Provide clinical oversight and consultation regarding admission status, level of care, medical necessity, and compliance with regulatory and payer requirements.
  • Conduct secondary reviews, support escalation of complex or disputed cases, and partner with the Lead and UM leadership to resolve barriers and promote consistent decision-making.
  • Participate in peer-to-peer discussions, denial prevention activities, and appeal support to strengthen payer outcomes and reduce avoidable denials.
  • Educate physicians, advanced practice providers, and UM/CM teams on documentation standards, admission criteria, medical necessity expectations, and compliant utilization practices.
  • Collaborate with Case Management, Social Work, CDI, Coding, HIM, Revenue Cycle, and operational leaders to improve care progression, patient flow, and reimbursement accuracy.
  • Identify and communicate trends in denials, documentation gaps, utilization patterns, and length-of-stay opportunities, and support performance improvement initiatives led by UM leadership.
  • Participate in assigned projects, committees, and organizational initiatives, and perform responsibilities in accordance with Penn Medicine and entity values, policies, and procedures.
  • Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
  • Other duties as assigned to support the unit, department, entity, and health system organization.

Credentials:
  • Must be a PA State Licensed Medical Doctor or Doctor of Osteopathic Medicine (Required).

Education or Equivalent Experience:
  • MD or DO is required.
  • 5+ years of clinical experience in a hospital setting is required.
  • 3+ years of knowledge of information technology including statistical analysis, medical informatics and electronic medical record documentation & clinical protocols is required.
  • Possess or develop a solid foundation in the areas of utilization management and hospital operations is required.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

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About Pennsylvania Medicine

The University of Pennsylvania is a private Ivy League research university in Philadelphia. It is the fourth-oldest institution of higher education in the United States and is ranked among the highest-regarded universities by numerous organizations and scholars. While the university dates its founding to 1740, it was created by Benjamin Franklin and leading Philadelphia citizens in 1749 . The University has four undergraduate schools as well as twelve graduate and professional schools. Schools enrolling undergraduates include the College of Arts and Sciences, the School of Engineering and Applied Science, the Wharton School, and the School of Nursing. Among its highly ranked graduate schools are its law school, whose first professor wrote the first draft of the United States Constitution, its medical school, the first in North America, and Wharton, the first collegiate business school. Penn's endowment is US$20.7 billion, putting it amongst the wealthiest academic institutions in the world, and its 2019 research budget was $1.02 billion. Penn was one of nine colonial colleges chartered before the U.S. Declaration of Independence when Benjamin Franklin, the university's founder and first president, advocated for an educational institution that trained leaders in academia, commerce, and public service. The campus, in the University City neighborhood of Philadelphia, is centered around College Hall, and notable landmarks are Houston Hall, the first modern "student union", and Franklin Field, the first double-decker college football stadium. Penn also is the home of the Morris Arboretum, the official arboretum of the Commonwealth of Pennsylvania, which is located 15 miles northwest of the campus, in the Chestnut Hill section of Philadelphia. The university's athletics program, the Quakers, fields varsity teams in 33 sports as a member of the NCAA Division I Ivy League conference.
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