Physician Advisor - Utilization & Denials (Hybrid)

MedStar Health; Columbia (MD); Hybrid; USD 250,000 - 350,000; Full time

Benefits offered by this job

Competitive salary

Medical, dental, and vision insurance

Paid malpractice insurance

Paid Time Off

Retirement plan

Job summary

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 uses medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials, ensuring timely and appropriate patient care.

You will review patient status and utilization, lead denial interventions, and collaborate with case management and hospital leadership.

Qualifications

• Minimum 5 years of direct clinical practice in a hospital setting.
• Strong knowledge of case management, utilization review, and regulatory standards.
• Experience with denials management and length of stay initiatives.
• Familiarity with MCG and InterQual criteria.

Responsibilities

• Review patient status, medical necessity, and level of care.
• Lead clinical denial interventions and denial root cause analyses.
• Engage in concurrent and retrospective denials management and payer discussions.
• Drive length of stay improvements with case management and stakeholders.
• Educate physicians and clinicians on regulatory requirements and hospital service utilization.
• Participate in Interdisciplinary Rounds (IDR) with the Healthcare Team.
• Ensure regulatory compliance of Utilization Management and Discharge processes.

Skills

Case management

Utilization review

Regulatory standards

Denials management

Observation medicine

Length of stay

Education

MD/DO

Board Certification

ACPA-C or ABQUARP certification

Job description

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 uses medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials, ensuring timely and appropriate patient care.

You will review patient status and utilization, lead denial interventions, and collaborate with case management and hospital leadership.