Physician Advisor

Physician Pivot; Worcester (MA); On-site; USD 180,000 - 280,000; Full time

Job summary

The Physician Advisor acts as a physician leader and strategic partner to hospital administration, medical staff, case management, CDI, HIM, and revenue cycle teams.

This non-clinical leadership role supports medically necessary, high-quality, and efficient patient care while advancing organizational goals related to patient throughput, length of stay, documentation integrity, denial prevention, regulatory compliance, and physician engagement.

Qualifications

• MD or DO degree required.
• Active/unrestricted medical license required.
• Board certification by an ABMS-recognized specialty board required.
• Active or recent hospital-based clinical practice experience preferred.

Responsibilities

• Perform secondary physician reviews and medical necessity determinations.
• Conduct peer-to-peer discussions with payer medical directors.
• Support denial prevention, appeal, and overturn activities.
• Collaborate with case management and utilization management teams regarding level-of-care determinations.
• Provide physician leadership and support for utilization management initiatives and committees.
• Participate in multidisciplinary rounds and patient throughput activities.
• Support observation management and length-of-stay optimization initiatives.
• Partner with CDI and HIM teams to improve documentation quality and compliance.
• Conduct one-on-one physician education and coaching based on data-driven outlier performance.

Education

Doctor of Medicine Degree (M.D.) or Doctor of Osteopathic Medicine Degree (D.O.)

Active/unrestricted medical license

Board certification by an ABMS-recognized specialty board

Job description

Job Summary

The Physician Advisor serves as a physician leader and strategic partner to hospital administration, medical staff, case management, utilization management, clinical documentation integrity (CDI), health information management (HIM), and revenue cycle teams. This non-clinical leadership role supports the delivery of medically necessary, high-quality, and efficient patient care while advancing organizational goals related to patient throughput, length of stay, documentation integrity, denial prevention, regulatory compliance, and physician engagement. The Physician Advisor collaborates closely with physicians, nursing leadership, case management, CDI, HIM, and executive leadership to improve clinical, operational, quality, and financial outcomes across the organization.

Job Summary

The Physician Advisor serves as a physician leader and strategic partner to hospital administration, medical staff, case management, utilization management, clinical documentation integrity (CDI), health information management (HIM), and revenue cycle teams. This non-clinical leadership role supports the delivery of medically necessary, high-quality, and efficient patient care while advancing organizational goals related to patient throughput, length of stay, documentation integrity, denial prevention, regulatory compliance, and physician engagement. The Physician Advisor collaborates closely with physicians, nursing leadership, case management, CDI, HIM, and executive leadership to improve clinical, operational, quality, and financial outcomes across the organization.

Responsibilities

Perform secondary physician reviews and medical necessity determinations. Conduct peer-to-peer discussions with payer medical directors. Support denial prevention, appeal, and overturn activities. Collaborate with case management and utilization management teams regarding level-of-care determinations. Provide physician leadership and support for utilization management initiatives and committees. Participate in multidisciplinary rounds, eTEMPO, and patient throughput activities. Support observation management and length-of-stay optimization initiatives. Partner with CDI and HIM teams to improve documentation quality, accuracy, and compliance. Conduct one-on-one physician education and coaching based on identifying outlier performance through our data platforms. Serve as a liaison between medical staff and hospital leadership.

Qualifications

Education

Required: Doctor of Medicine Degree (M.D.) or Doctor of Osteopathic Medicine Degree (D.O.).

Experience

Required: Active or recent hospital-based clinical practice experience.

Preferred: Prior Physician Advisor experience. Utilization Management experience. CDI or Case Management experience. Medical Staff leadership experience. Experience with MCG and/or InterQual criteria. Familiarity with Medicare Advantage, Medicaid, and Commercial payer processes.

Certifications

Required: Active unrestricted medical license. Board certification by an ABMS-recognized specialty board.

Physical Demands

Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: http://www.uscis.gov/e-verify The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.

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Perform secondary physician reviews and medical necessity determinations. Conduct peer-to-peer discussions with payer medical directors. Support denial prevention, appeal, and overturn activities. Collaborate with case management and utilization management teams regarding level-of-care determinations. Provide physician leadership and support for utilization management initiatives and committees. Participate in multidisciplinary rounds, eTEMPO, and patient throughput activities. Support observation management and length-of-stay optimization initiatives. Partner with CDI and HIM teams to improve documentation quality, accuracy, and compliance. Conduct one-on-one physician education and coaching based on identifying outlier performance through our data platforms. Serve as a liaison between medical staff and hospital leadership.