Physician Advisor: Utilization & Care Management Leader

Ensemble Health Partners; Blue Ash (OH); On-site; USD 198,000 - 297,000; Full time

Benefits offered by this job

Comprehensive benefits package

Tuition reimbursement

Professional certification support

Job summary

Ensemble Health Partners seeks an experienced Physician Advisor to lead utilization management across hospital services, ensuring appropriate levels of care and documentation. You will work with medical leadership to optimize resource use, provide education to staff, and report to executive committees.

A strong background in peer-to-peer reviews and denials management is essential. Role requires MD/DO, certification, and a collaborative approach to drive compliant, cost-effective care.

Qualifications

• MD/DO physician licensed and board-certified (or eligible).
• Experience in utilization management and peer-to-peer review is a plus.

Responsibilities

• Determine status for hospitalized patients and perform peer-to-peer reviews with payor medical directors.
• Conduct short inpatient stay reviews and daily observation reviews.
• Educate medical staff on utilization management topics and protocols.
• Partner with UR nurses, IA staff and Case Management to improve UM processes.
• Attend UM committees as subject matter expert and provide data-driven insights.
• Assist with denials and appeals as appropriate.
• Track denial trends to adapt to payor requirements.

Skills

Leadership

Program/Project Management

Education

MD/DO Physician (MUST have)

Job description

Ensemble Health Partners seeks an experienced Physician Advisor to lead utilization management across hospital services, ensuring appropriate levels of care and documentation. You will work with medical leadership to optimize resource use, provide education to staff, and report to executive committees.

A strong background in peer-to-peer reviews and denials management is essential. Role requires MD/DO, certification, and a collaborative approach to drive compliant, cost-effective care.