Hybrid Multisite Physician Advisor - Utilization & Denials

MedStar Health; Maryland; Hybrid; USD 250,000 - 350,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid malpractice insurance

Paid Time Off

Retirement plan

Job summary

MedStar Health seeks a Physician Advisor to join our system in a hybrid role supporting hospitals across the MedStar Health System. The physician advisor uses medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials, ensuring patients receive appropriate, timely care.

Responsibilities include reviewing patient status and utilization, leading denial interventions, engaging with payers, and providing education on regulatory requirements and clinical criteria.

Qualifications

• MD or DO with board certification in Internal or Emergency Medicine.
• Minimum 5 years direct clinical practice.
• Hospital-based experience preferred.
• Knowledge of case management, utilization review, and denials management.
• Familiarity with MCG and InterQual criteria.

Responsibilities

• Review patient status, medical necessity, and level of care.
• Lead clinical denial interventions and root-cause determinations.
• Engage in concurrent and retrospective denials management with payers.
• Drive length of stay improvements with case management and stakeholders.
• Provide education on regulatory requirements and hospital utilization.
• Participate in IDR and ensure compliance of UM and discharge processes.

Skills

Clinical experience

Regulatory knowledge

Utilization review

Denials management

InterQual MCg familiarity

Education

MD/DO

Board Certification

ACPA-C ABQUARP preferred

Job description

MedStar Health seeks a Physician Advisor to join our system in a hybrid role supporting hospitals across the MedStar Health System. The physician advisor uses medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials, ensuring patients receive appropriate, timely care.

Responsibilities include reviewing patient status and utilization, leading denial interventions, engaging with payers, and providing education on regulatory requirements and clinical criteria.