Physician Advisor – Pittsburgh, PA

Allegheny Health Network; Pittsburgh (Allegheny County); On-site; USD 175,000 - 225,000; Full time

Job summary

Allegheny Health Network in Pittsburgh, PA is seeking a full-time Physician Advisor to optimize the use of healthcare services. This role involves level-of-care reviews, collaboration with a multidisciplinary team, and conducting peer discussions with payers. Candidates should have at least 5 years of clinical practice experience, an MD or DO degree, and board certification in any medical specialty. Benefits include participation in quality initiatives and opportunities for education within the healthcare team.

Qualifications

• 5 years of clinical practice experience in a hospital setting.
• Must be licensed in the state of Pennsylvania prior to employment.

Responsibilities

• Ensure appropriate use of healthcare services for patients.
• Collaborate with interdisciplinary care team including physicians and case managers.
• Discuss cases with insurance company medical directors for authorization.

Skills

Clinical practice experience

Medical necessity evaluation

Interdisciplinary collaboration

Peer-to-peer discussions

Education

Doctor of Medicine (MD) or Doctor of Osteopathy (DO)

Board certification in any medical subspecialty

Job description

General Overview

The Allegheny Health Network (AHN) is recruiting a full-time Physician Advisor to join our team located in Pittsburgh, PA. This job ensures the most cost‑effective and appropriate use of health care services for patients treated at Allegheny Health Network, while correlating patient clinical information with government and commercial payer regulations and criteria regarding severity of illness, intensity of service, and the appropriateness of the setting for care administration. The Physician Advisor is responsible for level‑of‑care reviews and peer‑to‑peer discussions with payers if denials arise. The role requires significant collaboration with the hospital’s interdisciplinary care team, including physicians, case managers, UM nurses, and hospital leadership. The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise‑level quality and throughput initiatives. This position reports to the Chief Quality Officer and Medical Director of Physician Advisors.

Duties

• Position requires onsite hospital presence.
• Work in concert with the admitting physician, case management, and other personnel to evaluate medical necessity and appropriateness of admission, utilization of observation status and services, continued stay, and ancillary services ordered, and discuss cases with attending physicians when appropriate.
• When requested, discuss case with the insurance company medical director to obtain payer authorization or conduct a peer‑to‑peer discussion in cases of denial.
• Provide medical expertise, advice, and support to the Case Management Department.
• Provide education to medical staff regarding medical necessity and appropriateness of health care services.
• Provide ongoing education to residents and colleagues regarding observation status and case management.
• Assist with appeal letters and participate in data collection activities for utilization management.
• Receive daily report from Nursing Service (Bed Management) and case management on all observation cases.
• Review status of observation cases, facilitate use of institutional processes, and communicate with attending physicians and case managers regarding the patient’s status. Conduct interdisciplinary rounds to drive quality and reduce length of stay in concert with case management, physicians, and the multidisciplinary team.
• Interact regularly with coding and clinical documentation specialists.
• Be an active member of the Utilization Management Committee, lead and report data on case management and observation services at the monthly Throughput Meeting.
• Review and analyze metric reporting dashboards and implement action plans if goals are not met.

Qualifications

Minimum

• 5 years of clinical practice experience in a hospital setting.
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
• Board Certified in any medical subspecialty.
• Licensed in the state of Pennsylvania prior to employment.

Preferred

• Board Certified in Quality/Physician Advising.
• Physician Advisor experience in a clinical setting.
• Physician Advisor experience with cross‑functional teams.
• Physician Advisor experience with a large health system.
• Physician Advisor experience with an integrated payer/provider network.

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