Part Time Physician Advisor - Pittsburgh, PA

Highmark Health•Monroeville, PA

1d•Hybrid

About The Position

Within AHN East, the Physician Advisor supports Forbes Hospital and Allegheny Valley Hospital, partnering with site leaders and network teams to advance quality, utilization, and patient-flow priorities. The role promotes clinically appropriate, cost-effective care that aligns patient needs with regulatory and payer requirements for medical necessity, level of care, and care setting. It conducts level-of-care reviews, supports denial prevention and appeals, and holds peer-to-peer discussions with payer medical directors. The Physician Advisor works with physicians, case management, utilization management, nursing, coding, clinical documentation, and hospital leadership, and serves as an active member of the Utilization Management Committee. The position reports to the Chief Quality Officer and the Medical Director of Physician Advisors. The role has a regular onsite presence primarily at Forbes Hospital within a hybrid work model, with intermittent presence at Allegheny Valley Hospital focused largely on education and engagement with hospital executive leadership.

Requirements

MD or DO degree.
Board certification in a medical specialty or subspecialty.
At least five years of clinical practice experience in a hospital setting.
Eligibility for an unrestricted Pennsylvania medical license; licensure is required before employment.
Ability to obtain and maintain medical staff credentials within Allegheny Health Network.

Nice To Haves

Certification or advanced training in physician advising, healthcare quality, or utilization management.
Experience as a Physician Advisor in an acute-care setting.
Experience leading cross-functional work within a large health system.
Experience working within an integrated payer-provider organization.

Responsibilities

Maintain a regular onsite presence primarily at Forbes Hospital within a hybrid work model, with intermittent presence at Allegheny Valley Hospital.
Review admissions, observation services, continued stays, and ancillary services for medical necessity, level-of-care accuracy, and appropriate care setting.
Collaborate with attending physicians, case managers, utilization management nurses, nursing leaders, and hospital leadership to resolve complex cases and support timely care progression.
Conduct peer-to-peer discussions with payer medical directors and support authorization, denial prevention, and appeals.
Monitor observation cases, communicate status recommendations, and facilitate established escalation and review processes.
Participate in interdisciplinary rounds to improve quality, care coordination, throughput, and length of stay.
Provide clinical expertise and education to medical staff, residents, case management, and utilization management teams on medical necessity, documentation, observation status, and payer requirements.
Partner with coding and clinical documentation specialists to strengthen documentation accuracy and support appropriate reimbursement.
Serve as an active member of the Utilization Management Committee and provide physician leadership for case management, observation, and throughput priorities.
Review performance dashboards, identify trends, and lead action plans when utilization or throughput goals are not met.