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