Physician Advisor Director — Utilization & Quality Leader

Boston Medical Center; United States; On-site; USD 148,000 - 267,000; Full time

Benefits offered by this job

Competitive salary

Paid time off

Free parking

MTA bus pass subsidy

Onsite fitness center

Tuition assistance

Health, dental, vision

Retirement plan

Job summary

GBMC HealthCare seeks a Physician Advisor Director to lead a team of physician advisors supporting case management, UR, social work, and coding. This role ensures cost-efficient, high-quality inpatient and observation care with robust level of care decisions and denials management.

The position requires an MD with board certification, MD licensure in Maryland, and 5+ years in utilization/quality management, including education and regulatory familiarity.

Qualifications

• Graduate of an accredited medical program with ongoing education in utilization/quality management.
• Board-certified physician with applicable specialty and Maryland licensure.
• Experience in Utilization Management and Clinical Quality Management; 5+ years of clinical experience.

Responsibilities

• Provide clinical direction and leadership for UM, Case Management, UR, Social Work, and related teams.
• Oversee level of care reviews, denial reviews, and appeals management.
• Collaborate with department leaders to align care with evidence-based standards and regulatory requirements.
• Lead and coordinate education across physicians and other clinicians on disease coding, documentation, and reimbursement.

Skills

Utilization Management

Quality Management

Leadership

Regulatory Knowledge

Education/Training

Education

MD degree

Board Certification in Internal Medicine

State medical license

Utilization/Quality management education

Tools

EHR systems

ICD coding

CMS rules

Job description

GBMC HealthCare seeks a Physician Advisor Director to lead a team of physician advisors supporting case management, UR, social work, and coding. This role ensures cost-efficient, high-quality inpatient and observation care with robust level of care decisions and denials management.

The position requires an MD with board certification, MD licensure in Maryland, and 5+ years in utilization/quality management, including education and regulatory familiarity.