Physician Advisor - FT

Sinai-Grace Hospital; Worcester (MA); On-site; USD 190,000 - 260,000; Full time

Job summary

Sinai-Grace Hospital is seeking a Physician Advisor to lead clinical and administrative initiatives, collaborating with medical staff and hospital leadership to optimize patient care, documentation integrity, and regulatory compliance.

The role focuses on medical necessity reviews, education, and multidisciplinary partnership to improve outcomes and reduce length of stay. Requires MD/DO and active medical license with board certification.

Qualifications

• Education: Doctor of Medicine or Doctor of Osteopathic Medicine.
• Experience: Active or recent hospital-based clinical practice.
• Preferred: Physician Advisor experience; Utilization Management; CDI or Case Management leadership.
• Certifications: Active unrestricted medical license and ABMS board certification.

Responsibilities

• Perform secondary physician reviews and medical necessity determinations.
• Conduct peer-to-peer discussions with payer medical directors.
• Support denial prevention, appeal, and overturn activities.
• Collaborate with case management and utilization management on level-of-care determinations.
• Provide physician leadership for utilization management initiatives and committees.
• Participate in multidisciplinary rounds, eTEMPO, and patient throughput activities.
• Support observation management and length-of-stay optimization initiatives.
• Partner with CDI and HIM teams to improve documentation quality and compliance.
• Conduct physician education and coaching based on data analytics.

Skills

Leadership

Medical leadership

Cross-functional collaboration

Education & coaching

Education

MD/DO

Tools

MCG criteria

InterQual criteria

Job description

Job Summary

The Physician Advisor serves as a physician leader and strategic partner to hospital administration, medical staff, case management, utilization management, clinical documentation integrity (CDI), health information management (HIM), and revenue cycle teams. This non-clinical leadership role supports the delivery of medically necessary, high-quality, and efficient patient care while advancing organizational goals related to patient throughput, length of stay, documentation integrity, denial prevention, regulatory compliance, and physician engagement.

The Physician Advisor collaborates closely with physicians, nursing leadership, case management, CDI, HIM, and executive leadership to improve clinical, operational, quality, and financial outcomes across the organization.

Responsibilities

• Perform secondary physician reviews and medical necessity determinations.
• Conduct peer-to-peer discussions with payer medical directors.
• Support denial prevention, appeal, and overturn activities.
• Collaborate with case management and utilization management teams regarding level-of-care determinations.
• Provide physician leadership and support for utilization management initiatives and committees.
• Participate in multidisciplinary rounds, eTEMPO, and patient throughput activities.
• Support observation management and length-of-stay optimization initiatives.
• Partner with CDI and HIM teams to improve documentation quality, accuracy, and compliance.
• Conduct one-on-one physician education and coaching based on identifying outlier performance through our data platforms.
• Serve as a liaison between medical staff and hospital leadership.

Qualifications

• Education: Required: Doctor of Medicine Degree (M.D.) or Doctor of Osteopathic Medicine Degree (D.O.).
• Experience: Required: Active or recent hospital-based clinical practice experience.
• Preferred: Prior Physician Advisor experience. Utilization Management experience. CDI or Case Management experience. Medical Staff leadership experience. Experience with MCG and/or InterQual criteria. Familiarity with Medicare Advantage, Medicaid, and Commercial payer processes.
• Certifications: Required: Active unrestricted medical license. Board certification by an ABMS-recognized specialty board.

Physical Demands

Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.

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