Physician Advisor: Evidence-Based Utilization & Guidance

Med-Metrix; Chicago (IL); On-site; USD 120,000 - 180,000; Full time

Job summary

Med-Metrix in Chicago, IL seeks a Physician Advisor to conduct physician-to-physician reviews, guide clinical decisions and promote evidence-based utilization.

You will support utilization review, assist with documentation, stay current with CMS and MCG guidelines, and ensure compliance with HIPAA across the team.

Requires MD/DO, US board certification, and at least 1 year in payor or provider-side utilization review; strong communication and EMR skills.

Qualifications

• MD or DO with an active, unrestricted medical license.
• US Board Certified in a recognized specialty.
• Minimum of 1 year of payor or provider-side utilization review or ACPA/ABQUARP certification.
• Basic technical skills with hospital EMRs.
• Strong knowledge of utilization management and payer regulations.
• Familiarity with MCG/InterQual criteria is preferred.
• ACPA membership preferred.
• Excellent communication and judgment.

Responsibilities

• Conduct physician-to-physician reviews for medical necessity and denial prevention.
• Support utilization review and case management with complex decisions.
• Communicate with hospital physicians and care teams to promote evidence-based care.
• Improve documentation related to ICD coding and DRG assignment.
• Maintain compliance with HIPAA, legal and accreditation requirements.
• Meet productivity and quality standards within time requirements.
• Participate in peer review as needed.
• Stay updated on CMS and MCG guidelines.

Skills

Medical terminology

Communication skills

Analytical thinking

HIPAA compliance

Microsoft Office

Education

MD or DO with active medical license

US Board Certification

Tools

EMR systems

Clinical documentation software

Job description

Med-Metrix in Chicago, IL seeks a Physician Advisor to conduct physician-to-physician reviews, guide clinical decisions and promote evidence-based utilization.

You will support utilization review, assist with documentation, stay current with CMS and MCG guidelines, and ensure compliance with HIPAA across the team.

Requires MD/DO, US board certification, and at least 1 year in payor or provider-side utilization review; strong communication and EMR skills.