Physician Advisor Jobs

About The Position

Requirements

• Specialty board certification.
• Licensed to practice medicine in the United States.
• At least 3 years of experience working as a Physician Advisor or UR/UM Medical Director performing case reviews.
• Basic technical skills with hospital EMRs, Microsoft Office, and Teams.
• Hold and maintain an unrestricted medical license and board certification.
• Possess or acquire a solid foundation, knowledge, and/or experience in utilization management, quality improvement, and patient safety.
• Working knowledge of hospital organization, case management operations, and administrative standards and policies.
• Proficiency in Microsoft Office Suite.
• Strong interpersonal skills and ability to communicate well at all levels of the organization.
• Strong problem-solving and creative skills, sound judgment, and ability to make decisions based on accurate and timely analyses.
• High integrity and dependability, a strong sense of urgency, and a results-oriented approach.
• Excellent written and verbal communication skills.
• Ability to follow directions, collaborate with others, and handle stress.
• Possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

Nice To Haves

• Familiarity with MCG/InterQual placement status criteria.
• Membership in the American College of Physician Advisors (ACPA).
• Board certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP).
• Physician Advisor Sub-Specialty Certification by ABQAURP.

Responsibilities

• Respond in a timely manner to requests for assistance with clinical reviews, including medical necessity reviews, from Case Management department members.
• Consult with attending physicians, nurses, and case management staff on complex clinical issues and advise on justification for continued stay, medical necessity, and utilization management.
• Apply published criteria such as MCG/InterQual alongside professional judgment and patient-specific factors.
• Support case management outcomes and the medical staff in the clinical progression of patient care.
• Recommend health record documentation improvements that affect ICD code assignment, severity, acuity, risk of mortality, and DRG assignment.
• Participate in ongoing training and education related to the Physician Advisor role, utilization management, care management, and other related areas.
• Meet production standards, time requirements, quality standards, and performance goals.
• Maintain confidentiality of patient care and business matters and comply with HIPAA and information security policies.
• Support the organization’s mission, strategic initiatives, values, and Code of Conduct.
• Facilitate, mentor, and educate physicians regarding payer requirements.
• Attend meetings requested by PAOC leadership and participate in peer review when necessary or requested.
• Maintain medical licensure and board certification in good standing.
• Manage PAOC client relationships, direct quarterly report creation and JOCs in coordination with the Director of Operations, and support customer satisfaction and retention.
• Contribute to PAOC’s Quality program and ongoing Physician Advisor development.
• Educate client facility staff on relevant topics.
• Mentor and train new and existing Physician Advisors to promote consistent, high-quality determinations.
• Serve as Physician Advisor team lead for dashboard management as scheduled.
• Perform additional duties as needed within the Physician Advisor II role.