Physician Advisor—Clinical Appeals & Utilization (FT)

Temple University Health System; United States; On-site; USD 210,000 - 260,000; Full time

Job summary

Temple University Hospital is seeking a Physician Advisor to provide clinical expertise and guidance to the Clinical Analysis and appeals team. This full-time role focuses on medical necessity appeals and PAMA utilization reviews, serving as a physician resource for regulatory and revenue cycle denial and appeals.

The candidate will bring strong knowledge of Interqual criteria, managed care experience, and a background in administrative leadership to drive decisions across hospital activity and

Qualifications

• Interqual Criteria knowledge required.
• Experience handling medical necessity appeals and denials.
• Experience as expert witness in healthcare settings.
• Experience in a managed care environment.
• Administrative leadership experience preferred.

Responsibilities

• Provide clinical expertise to the Clinical Analysis and appeals team.
• Act as physician advisor for medical necessity appeals and PAMA utilization reviews.
• Support regulatory and revenue cycle denial and appeals processes for hospital activity.

Skills

Interqual knowledge

Medical necessity appeals

Expert witness experience

Managed care experience

Administrative leadership

Education

Doctorate MD/DO

Job description

Temple University Hospital is seeking a Physician Advisor to provide clinical expertise and guidance to the Clinical Analysis and appeals team. This full-time role focuses on medical necessity appeals and PAMA utilization reviews, serving as a physician resource for regulatory and revenue cycle denial and appeals.

The candidate will bring strong knowledge of Interqual criteria, managed care experience, and a background in administrative leadership to drive decisions across hospital activity and