Physician Advisor: Clinical Utilization & Care Optimization

Med-Metrix; Chicago, Northern (IL, KY); Hybrid; USD 140,000 - 190,000; Full time

Job summary

Med-Metrix is seeking a Physician Advisor to perform case reviews across all types, ensuring medical necessity and optimal use of hospital resources. You will collaborate with medical staff leadership, case management, discharge planning and utilization management to improve documentation, coding accuracy, and patient care efficiency.

The role requires board certification and an unrestricted US license, with 3+ years of US clinical experience.

Qualifications

• Board-certified and US licensed physician; able to practice medicine in the US.
• Minimum 3+ years of active US clinical experience as a physician advisor.
• Unrestricted license and current board certification required.
• Knowledge of utilization management concepts and payer criteria preferred.
• Strong communication, analytical and documentation skills.
• Experience with EMR systems and hospital workflows.

Responsibilities

• Respond to requests for clinical reviews related to medical necessity in a timely manner.
• Consult with attendings, nurses and case management on complex issues and stay decisions.
• Apply standard criteria (MCG/InterQual) with professional judgment and patient context.
• Support medical staff to optimize patient care and resource use.
• Identify opportunities to improve documentation for accurate coding and DRG assignment.
• Participate in training on Utilization and Care Management topics as requested.
• Meet productivity and quality standards and performance goals per agreement.
• Maintain patient confidentiality and HIPAA compliance.
• Mentor physicians on payer requirements and participate in peer reviews as needed.

Skills

Analytical skills

Communication

Interpersonal skills

MS Office

Problem solving

Presentation skills

Education

Board Certified & US licensed

3+ years US clinical experience

Unrestricted medical license & board certification

Familiarity with MCG/InterQual

ACPA/ABQAURP qualifications preferred

Tools

Hospital EMRs

Job description

Med-Metrix is seeking a Physician Advisor to perform case reviews across all types, ensuring medical necessity and optimal use of hospital resources. You will collaborate with medical staff leadership, case management, discharge planning and utilization management to improve documentation, coding accuracy, and patient care efficiency.

The role requires board certification and an unrestricted US license, with 3+ years of US clinical experience.