Physician Advisor

***WE ARE CURRENTLY FULLY STAFFED, BUT OUR NEEDS CAN CHANGE AT ANY TIME,
AND WE ARE STILL ACCEPTING APPLICATIONS***
The Physician Advisor provides physician-to-physician reviews, clinical guidance, education, and escalation support while promoting evidence-based practices and appropriate resource utilization.
Key Responsibilities
Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals
Support utilization review and case management teams with complex clinical decision-making
Ensure appropriate admission status determinations (inpatient vs. observation) in alignment with CMS and payer guidelines
Provide clinical oversight related to length of stay, care progression, and discharge planning
Ensure adherence to CMS Conditions of Participation, Medicare regulations, and payer policies
Support compliance with medical necessity criteria (InterQual, MCG, or equivalent)
Assist with audit preparedness and response, including RAC, MAC, and commercial payer audits
Partner with HIM/CDI teams to improve documentation quality and clinical accuracy
Education & Physician Engagement
Serve as a trusted peer resource to attending physicians and advanced practice providers
Educate medical staff on regulatory requirements, utilization best practices, and documentation standards
Support change management initiatives related to clinical operations and compliance
Qualifications
Required
MD or DO with an active, unrestricted medical license
Board-certified or board-eligible in a recognized specialty
Clinical practice experience in an acute care or relevant healthcare setting
Strong knowledge of utilization management, medical necessity, and payer regulations
Excellent communication skills with the ability to conduct peer-to-peer discussions
Preferred
Prior experience as a Physician Advisor, Medical Director, or in Utilization Review
Familiarity with CMS guidelines, InterQual, MCG, and denial management processes
Experience working with case management, CDI, HIM, or revenue cycle teams
Experience in a remote or consulting healthcare environment
Skills & Competencies
Physician-to-physician negotiation and collaboration
Clinical judgment balanced with regulatory and financial awareness
Data-driven decision-making
Ability to influence without authority
Strong written and verbal communication

Employment type
Contractor

Work arrangement
Yes