Physician Advisor - MedStar Multisite

MedStar Health; Maryland; Hybrid; USD 250,000 - 350,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid malpractice insurance

Paid Time Off

Retirement plan

Job summary

MedStar Health seeks a Physician Advisor to join our system in a hybrid role supporting hospitals across the MedStar Health System. The physician advisor uses medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials, ensuring patients receive appropriate, timely care.

Responsibilities include reviewing patient status and utilization, leading denial interventions, engaging with payers, and providing education on regulatory requirements and clinical criteria.

Qualifications

• MD or DO with board certification in Internal or Emergency Medicine.
• Minimum 5 years direct clinical practice.
• Hospital-based experience preferred.
• Knowledge of case management, utilization review, and denials management.
• Familiarity with MCG and InterQual criteria.

Responsibilities

• Review patient status, medical necessity, and level of care.
• Lead clinical denial interventions and root-cause determinations.
• Engage in concurrent and retrospective denials management with payers.
• Drive length of stay improvements with case management and stakeholders.
• Provide education on regulatory requirements and hospital utilization.
• Participate in IDR and ensure compliance of UM and discharge processes.

Skills

Clinical experience

Regulatory knowledge

Utilization review

Denials management

InterQual MCg familiarity

Education

MD/DO

Board Certification

ACPA-C ABQUARP preferred

Job description

About the Job

Physician Advisor - MedStar Multisite

MedStar Health is seeking a Physician Advisor to join our team in a hybrid role supporting hospitals across the MedStar Health System. The Physician Advisor is an essential part of the team, using medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials. Their work ensures patients receive appropriate, timely care.

In this role, you’ll:

• Review patient status, medical necessity, and level of care
• Lead clinical denial interventions, denial root cause determinations and upstream process improvement initiatives
• Engage in concurrent and retrospective denials management and peer to peer discussions with payers
• Drive length of stay improvements in close collaboration with case management and hospital stakeholders
• Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative level of care
• Participate in Interdisciplinary Rounds (IDR) with the Healthcare Team as indicated
• Ensure regulatory compliance of Utilization Management and Discharge planning processes

At MedStar Health, you can expect:

• A competitive salary
• Medical, dental, and vision insurance
• Paid malpractice insurance
• Paid Time Off
• Retirement plan

Education/Training:

• Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) -Board Certification required (Internal Medicine or Emergency Medicine preferred)
• Preferred: Additional certification in healthcare administration, business, or physician advisory

Experience:

• Minimum 5 years of direct clinical practice required, hospital based experience preferred
• Previous experience as physician advisor preferred
• Strong knowledge of case management, utilization review, regulatory standards, denials management, observation medicine, and length of stay
• Familiarity with MCG and InterQual clinical criteria

Licensure/Certification:

• Current medical license in the practicing state
• Board Certified
• Preferred: ACPA-C or ABQUARP certification in Physician Advisory (or willingness to obtain within 1 year of hire) #LI-SS1

This position has a hiring range of USD $250,000.00 - USD $350,000.00 /Yr.