Physician Advisor, Utilization & Medical Necessity

Indiana University Health System; Indiana (PA); On-site; USD 180,000 - 210,000; Full time

Job summary

Indiana University Health is seeking a Physician Advisor to help optimize hospital services and medical necessity reviews. This role acts as a liaison among Revenue Cycle Services, hospital administration, and clinical staff.

You will provide clinical expertise to the Utilization Management team, ensure HIPAA confidentiality, and lead data-driven analyses to improve care and compliance. Join a system that values mission, excellence and teamwork, and impact outcomes for Hoosiers.

Qualifications

• Medical degree and board certification in a recognized medical or surgical specialty required.
• Relevant experience preferred.
• Current licensure to practice medicine.
• Clinical experience in a hospital setting.
• Understanding of clinical utilization review and healthcare regulations.
• Knowledge of current medical coding and billing practices.
• Excellent communication and interpersonal skills.
• Strong leadership abilities and a collaborative approach to problem-solving.
• Knowledge in Medical Necessity, healthcare regulatory requirements, and medical coding and billing.

Responsibilities

• Liaise between Revenue Cycle, administration and clinical staff to optimize hospital services.
• Support Utilization Management with authorizations, reviews, and payor denials.
• Maintain HIPAA confidentiality and handle records with discretion.
• Analyze problems and opportunities to inform decisions.
• Collaborate with teams; mentor staff and share best practices.
• Exercise independent judgment when facing unexpected problems.

Skills

Excellent communication

Leadership abilities

Collaboration

Critical thinking

Independent judgment

Medical terminology

Healthcare regulations knowledge

Education

Medical degree

Board certification in medical/surgical specialty

Job description

Indiana University Health is seeking a Physician Advisor to help optimize hospital services and medical necessity reviews. This role acts as a liaison among Revenue Cycle Services, hospital administration, and clinical staff.

You will provide clinical expertise to the Utilization Management team, ensure HIPAA confidentiality, and lead data-driven analyses to improve care and compliance. Join a system that values mission, excellence and teamwork, and impact outcomes for Hoosiers.