Physician Advisor: Clinical Leadership & Denial Prevention

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

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.