Physician Advisor Director: Utilization & Quality Leadership

gbmc; Towson (MD); On-site; USD 148,000 - 267,000; Full time

Job summary

GBMC HealthCare in Towson, MD seeks a Physician Advisor Director to lead a multidisciplinary team focused on utilization management, case management, coding, and population health. The role oversees level of care reviews, denial reviews, and appeals, reporting to executive leadership.

The successful candidate will guide policy development, ensure regulatory compliance, and collaborate across departments to optimize hospital reimbursement and patient care outcomes.

Qualifications

• Graduate of an accredited medical program.
• MD license in Maryland.
• Board Certification in Internal Medicine or equivalent.

Responsibilities

• Provide clinical direction to care teams including Case Management, UR and Social Work.
• Lead and oversee level of care reviews and denial management.
• Develop and oversee policies for Physician Advisor services.
• Represent GBMC in accreditation and regulatory activities.
• Chairs the UM Medical Staff Committee and drives quality initiatives.
• Collaborate with CM, CDI, EHR and Revenue Cycle to improve program efficiency.

Skills

Physician leadership

Utilization management

Clinical quality management

Regulatory knowledge

Interpersonal communication

Education

MD degree

Utilization/Quality management CME

Job description

GBMC HealthCare in Towson, MD seeks a Physician Advisor Director to lead a multidisciplinary team focused on utilization management, case management, coding, and population health. The role oversees level of care reviews, denial reviews, and appeals, reporting to executive leadership.

The successful candidate will guide policy development, ensure regulatory compliance, and collaborate across departments to optimize hospital reimbursement and patient care outcomes.