Physician Advisor – Inpatient Utilization & Compliance

Trinity Health Of New England; Iowa (LA); On-site; USD 140,000 - 190,000; Full time

Benefits offered by this job

Paid malpractice

403B match

Job summary

MercyOne Central Iowa is seeking a dynamic, board-certified Physician Advisor with inpatient experience for a newly opened role. You will lead a physician-driven clinical resource utilization program, review cases for medical necessity, and advise on level of care within CMS and payer guidelines.

This position collaborates with MercyOne leadership and care teams to shape interventions, foster peer-to-peer protocol, and support oncology care strategy within the MercyOne system.

Qualifications

• Board-certified physician with inpatient experience.
• Strong knowledge of CMS and commercial insurance regulations.
• Experience serving on hospital committees or working with cross-functional teams.
• Ability to build teams and influence decision making.

Responsibilities

• Lead physician-driven clinical resource utilization program, and work with MercyOne Leadership team to design interventions when necessary
• Review cases to determine appropriate level of care based on medical necessity, and apply regulatory, health plan, and clinical guidelines in the review of denials
• Serve as a resource for physicians regarding medical necessity, level of care, and clinical documentation
• Foster effective communication between members of the care team
• Establish and maintain peer-to-peer protocol

Skills

Inpatient experience

CMS regulations

Team leadership

Collaboration

Medical decision making

Education

Board-certified physician

Job description

MercyOne Central Iowa is seeking a dynamic, board-certified Physician Advisor with inpatient experience for a newly opened role. You will lead a physician-driven clinical resource utilization program, review cases for medical necessity, and advise on level of care within CMS and payer guidelines.

This position collaborates with MercyOne leadership and care teams to shape interventions, foster peer-to-peer protocol, and support oncology care strategy within the MercyOne system.