Physician Advisor - Corporate

Penn Medicine; Bala Cynwyd (PA); Hybrid; USD 150,000 - 210,000; Full time

Job summary

Penn Medicine, a leading academic medical center, seeks a Physician Advisor to provide clinical leadership within Utilization Management and to support appropriate patient status determinations, medical necessity review, and regulatory compliance. The role centers on clinical consultation, education, and collaboration with interdisciplinary teams to optimize care progression and resource use.

Working in a hybrid environment at HUP/Corporate Services, the physician will contribute to performance

Qualifications

• MD/DO degree required and licensed in PA.
• Minimum 5 years of clinical hospital experience.
• At least 3 years of IT knowledge including EMR documentation and medical informatics.
• Solid foundation in utilization management and hospital operations.

Responsibilities

• Provide clinical oversight and consultation on admission status and level of care.
• Support medical necessity reviews and regulatory payer requirements.
• Assist in peer discussions, denial prevention, and appeal support.
• Educate physicians and UM/CM teams on documentation standards and criteria.
• Collaborate across Case Management, Social Work, CDI, Coding, HIM, Revenue Cycle, and operations.
• Identify trends in denials and utilization patterns to guide improvement initiatives.
• Participate in projects and organizational initiatives while upholding Penn Medicine values.
• Other duties to support the unit and health system.

Education

MD/DO required

Hosp clinical experience 5+ years

IT/EMR knowledge 3+ yrs

Utilization management/ hospital operations

Job description

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Entity: Corporate Services

Department:Corp Utilization Management

Location: HUP/ hybrid

Summary

The Physician Advisor serves as a key clinical leader within Utilization Management (UM), reporting to the AVP of Utilization Management and working in close partnership with the Lead to support appropriate patient status determinations, medical necessity review, and regulatory compliance. This role provides timely clinical consultation to UM, Case Management, and medical staff to promote accurate level-of-care decisions and effective use of healthcare resources.

In collaboration with the Lead and interdisciplinary partners, the Physician Advisor supports physician education, case escalation, documentation improvement, and denial prevention efforts across the continuum of care. Through case review, peer-to-peer engagement, and alignment with organizational and payer requirements, this role contributes to efficient care progression, improved patient outcomes, and strong operational and financial performance.

Responsibilities

• Provide clinical oversight and consultation regarding admission status, level of care, medical necessity, and compliance with regulatory and payer requirements.
• Conduct secondary reviews, support escalation of complex or disputed cases, and partner with the Lead and UM leadership to resolve barriers and promote consistent decision-making.
• Participate in peer-to-peer discussions, denial prevention activities, and appeal support to strengthen payer outcomes and reduce avoidable denials.
• Educate physicians, advanced practice providers, and UM/CM teams on documentation standards, admission criteria, medical necessity expectations, and compliant utilization practices.
• Collaborate with Case Management, Social Work, CDI, Coding, HIM, Revenue Cycle, and operational leaders to improve care progression, patient flow, and reimbursement accuracy.
• Identify and communicate trends in denials, documentation gaps, utilization patterns, and length-of-stay opportunities, and support performance improvement initiatives led by UM leadership.
• Participate in assigned projects, committees, and organizational initiatives, and perform responsibilities in accordance with Penn Medicine and entity values, policies, and procedures.
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
• Other duties as assigned to support the unit, department, entity, and health system organization.

Credentials

• Must be a PA State Licensed Medical Doctor or Doctor of Osteopathic Medicine (Required).

Education or Equivalent Experience

• MD or DO is required.
• 5+ years of clinical experience in a hospital setting is required.
• 3+ years of knowledge of information technology including statistical analysis, medical informatics and electronic medical record documentation & clinical protocols is required.
• Possess or develop a solid foundation in the areas of utilization management and hospital operations is required.

Benefits

• Our employee benefits programs help our employees get healthy and stay healthy.
• We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region.

We believe that the best care for our patients starts with the best care for our employees.

Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.