Physician Advisor: Clinical Strategy & Denial Prevention

Sinai-Grace Hospital; Worcester (MA); On-site; USD 190,000 - 260,000; Full time

Job summary

Sinai-Grace Hospital is seeking a Physician Advisor to lead clinical and administrative initiatives, collaborating with medical staff and hospital leadership to optimize patient care, documentation integrity, and regulatory compliance.

The role focuses on medical necessity reviews, education, and multidisciplinary partnership to improve outcomes and reduce length of stay. Requires MD/DO and active medical license with board certification.

Qualifications

• Education: Doctor of Medicine or Doctor of Osteopathic Medicine.
• Experience: Active or recent hospital-based clinical practice.
• Preferred: Physician Advisor experience; Utilization Management; CDI or Case Management leadership.
• Certifications: Active unrestricted medical license and ABMS board certification.

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 on level-of-care determinations.
• Provide physician leadership 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 and compliance.
• Conduct physician education and coaching based on data analytics.

Skills

Leadership

Medical leadership

Cross-functional collaboration

Education & coaching

Education

MD/DO

Tools

MCG criteria

InterQual criteria

Job description

Sinai-Grace Hospital is seeking a Physician Advisor to lead clinical and administrative initiatives, collaborating with medical staff and hospital leadership to optimize patient care, documentation integrity, and regulatory compliance.

The role focuses on medical necessity reviews, education, and multidisciplinary partnership to improve outcomes and reduce length of stay. Requires MD/DO and active medical license with board certification.