Physician Advisor – CDI, Denials & Utilization

Houston Methodist Clear Lake; Dayton (OH); On-site; USD 180,000 - 240,000; Full time

Job summary

Premier Health in Dayton, Ohio seeks a Physician Advisor – Utilization Management, Denials, CDI, Coding & Quality to lead clinical documentation integrity and coding excellence across the health system.

You will collaborate with CDI, Coding, Utilization Review, Care Management, and Quality teams to optimize observation rates, denials management, and risk adjustment, while educating providers and aligning with Vizient benchmarks.

Qualifications

• Education: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) required.
• Licensure: Active Ohio medical license (or eligibility for licensure).
• Experience: Minimum 3 years of clinical practice experience.
• CDI/Utilization Management: Prior involvement preferred 1-2 years.
• Knowledge: ICD-10, MS-DRG/APR-DRG, risk adjustment models Vizient/CMS/Elixhauser.

Responsibilities

• Provide secondary review of complex CDI and Coding queries escalated by CDI and Coding teams.
• Review escalations involving Query disagreement, Clinical Validation, or incomplete response.
• Partner with CDI Manager to establish escalation criteria and timely resolution of high-impact queries.
• Conduct focused reviews to identify missed documentation opportunities and support CMI improvement.
• Serve as a liaison between CDI, Coding, and Physician teams to promote documentation consistency.
• Deliver education sessions on documentation best practices and medical necessity.

Skills

Communication skills

Teaching ability

Clinical documentation interpretation

Peer-to-peer discussion skills

Education

MD/DO degree

Tools

Epic EHR

Job description

Premier Health in Dayton, Ohio seeks a Physician Advisor – Utilization Management, Denials, CDI, Coding & Quality to lead clinical documentation integrity and coding excellence across the health system.

You will collaborate with CDI, Coding, Utilization Review, Care Management, and Quality teams to optimize observation rates, denials management, and risk adjustment, while educating providers and aligning with Vizient benchmarks.