Physician Advisor - Pittsburgh, PA

Highmark Health • Monroeville, PA

2d • Hybrid

About The Position

The Physician Advisor supports Forbes Hospital and Allegheny Valley Hospital within AHN East, working with site leaders and network partners to advance quality, utilization, and patient-flow priorities. The role promotes clinically appropriate, cost-effective care by aligning patient needs with regulatory and payer requirements for medical necessity, level of care, and care setting. It performs level-of-care reviews, supports denial prevention and appeals, and conducts peer-to-peer discussions with payer medical directors.

Working closely with physicians, case management, utilization management, nursing, coding, clinical documentation, and hospital leadership, the Physician Advisor contributes to quality and patient-throughput initiatives 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. It maintains 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 and 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 appeal activities.
• 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.

Benefits

• Competitive compensation and comprehensive medical benefits.
• Sign-on bonus.
• CME allowance.
• EY financial-planning services, including student-loan and Public Service Loan Forgiveness support.
• 401(k) and 457(b) retirement plans with immediate vesting.
• Malpractice insurance with tail coverage.
• Loan-repayment assistance for qualified candidates.
• A diverse and inclusive workplace.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree