Physician Advisor
Core
Provides leadership for efficiently managing resource and utilization to deliver quality cost-effective care in the most appropriate setting, working closely with medical staff to optimize hospital service use.
Role type
Senior Physician Advisor (Utilization Management)
Builds
Care management protocols, utilization review processes, and peer-to-peer review frameworks for hospital systems.
Domain
Healthcare Revenue Cycle Management / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical decision making, resource utilization management, peer-to-peer review, care management protocol development, medical staff education, denial and appeals management, committee leadership, trend analysis
Preferred skills
Experience with short stay reviews, extended observation management, building relationships with medical leadership, UR nurse and case management partnership
Technologies
None explicitly stated
Responsibilities
Perform status determinations for hospitalized patients, conduct peer-to-peer reviews with payor medical directors, review observation patients daily, educate medical staff on utilization management topics, attend UM committees as subject matter expert, track denial trends to assist team evolution
Seniority
Senior, hands-on IC with leadership responsibilities