Physician Advisor - Utilization & Care Optimization

Penn Medicine, University of Pennsylvania Health System; Bala Cynwyd (PA); Hybrid; USD 140,000 - 210,000; Full time

Benefits offered by this job

Tuition assistance

Employee benefits

Job summary

Penn Medicine is seeking a Physician Advisor to serve as a clinical leader within Utilization Management, reporting to the AVP of Utilization Management. The role supports medical necessity determinations, peer-to-peer engagement, and documentation improvements across the continuum of care.

The ideal candidate will have MD or DO credentials with extensive hospital-based clinical experience and solid IT proficiency in EMR systems and medical informatics.

Qualifications

• MD or DO is required.
• 5+ years of clinical experience in a hospital setting is required.
• 3+ years of knowledge of information technology including statistical analysis, medical informatics and electronic medical record documentation & clinical protocols is required.

Responsibilities

• Provide clinical oversight and consultation regarding admission status, level of care, medical necessity, and compliance with regulatory and payer requirements.
• Conduct secondary reviews, support escalation of complex or disputed cases, and partner with the Lead and UM leadership to resolve barriers and promote consistent decision-making.
• Participate in peer-to-peer discussions, denial prevention activities, and appeal support to strengthen payer outcomes and reduce avoidable denials.
• Educate physicians, advanced practice providers, and UM/CM teams on documentation standards, admission criteria, medical necessity expectations, and compliant utilization practices.
• Collaborate with Case Management, Social Work, CDI, Coding, HIM, Revenue Cycle, and operational leaders to improve care progression, patient flow, and reimbursement accuracy.
• Identify and communicate trends in denials, documentation gaps, utilization patterns, and length-of-stay opportunities, and support performance improvement initiatives led by UM leadership.
• Participate in assigned projects, committees, and organizational initiatives, and perform responsibilities in accordance with Penn Medicine and entity values, policies, and procedures.

Skills

Clinical leadership

Regulatory compliance

Medical necessity

Peer-to-peer communication

Education

MD or DO

Tools

Health IT / EMR systems

Medical informatics

Job description

Penn Medicine is seeking a Physician Advisor to serve as a clinical leader within Utilization Management, reporting to the AVP of Utilization Management. The role supports medical necessity determinations, peer-to-peer engagement, and documentation improvements across the continuum of care.

The ideal candidate will have MD or DO credentials with extensive hospital-based clinical experience and solid IT proficiency in EMR systems and medical informatics.