Physician Advisor

HURC; United States; On-site; USD 120,000 - 180,000; Full time

Job summary

HURC in the United States is seeking a Physician Advisor to lead physician-to-physician reviews, provide clinical guidance, and support education and escalation processes while promoting evidence-based practices and appropriate resource utilization.

You will collaborate with utilization review, case management, HIM, and revenue cycle teams to ensure medical necessity, admission status, and regulatory compliance.

Qualifications

• MD/DO licensed with board certification in a recognized specialty.
• Clinical governance and regulatory knowledge are essential.
• Experience with CMS guidelines and payer regulations preferred.

Responsibilities

• Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention.
• Support utilization review and case management with complex clinical decisions.
• Ensure admission status determinations align with CMS and payer guidelines.
• Provide oversight on length of stay, care progression, and discharge planning.
• Assist with audits (RAC, MAC) and responses as needed.
• Collaborate with HIM/CDI teams to improve documentation quality.

Skills

Utilization management

Regulatory knowledge

Peer communication

Clinical judgment

Education

MD/DO

Job description

***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

Education & Physician Engagement

• Serve as a trusted peer resource to attending physicians and advanced practice providers
• Educate medical staff on regulatory requirements, utilization best practices, and documentation standards
• Support change management initiatives related to clinical operations and compliance

Qualifications Required

• MD or DO with an active, unrestricted medical license
• Board-certified or board-eligible in a recognized specialty
• Clinical practice experience in an acute care or relevant healthcare setting
• Strong knowledge of utilization management, medical necessity, and payer regulations
• Excellent communication skills with the ability to conduct peer-to-peer discussions

Preferred

• Prior experience as a Physician Advisor, Medical Director, or in Utilization Review
• Familiarity with CMS guidelines, InterQual, MCG, and denial management processes
• Experience working with case management, CDI, HIM, or revenue cycle teams
• Experience in a remote or consulting healthcare environment

Skills & Competencies

• Physician-to-physician negotiation and collaboration
• Clinical judgment balanced with regulatory and financial awareness
• Data-driven decision-making
• Ability to influence without authority
• Strong written and verbal communication

Originally posted on Himalayas