Full Job Description
The Physician Advisor is responsible for rendering compliant status determinations for hospitalized patients, conducting peer-to-peer reviews with payors' medical directors, and serving as a subject matter expert on utilization management (UM) issues. They review short inpatient stays and observation patients daily, while building strong relationships with medical staff and leadership to gain support for UM initiatives. Includes attending UM committees, assisting with denials and appeals, and educating medical staff on UM topics. The Physician Advisor partners with utilization review nurses, insurance authorization staff, and Case Management to strengthen UM processes, and tracks denial trends to help the team adapt to evolving payor challenges.
