Physician Advisor: Utilization & Quality Leader

Wellstar Health System, Inc.; Douglas (GA); On-site; USD 180,000 - 240,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Physician Advisor for Wellstar Douglas Hospital to enhance quality, utilization and patient satisfaction through Performance Improvement initiatives and medical education.

The PA will review cases for medical necessity, advise on appropriate levels of care, and collaborate with care teams to optimize outcomes. The role emphasizes readmission reduction, denial management, and development of evidence-based guidelines, requiring leadership, clinical

Qualifications

• MD/DO degree and board certification in a medical specialty (preferred).
• Experience leading physician-level quality and utilization initiatives.
• Strong communication and collaboration across care teams and leadership.

Responsibilities

• Assess medical necessity and appropriate level of care across inpatient/outpatient settings.
• Lead readmission reduction initiatives with hospital leadership.
• Assist with denial management, concurrent reviews and payer communications.
• Collaborate with care coordination teams to streamline case management workflows.
• Review clinical documentation for accuracy and support of medical necessity and level of care.
• Coordinate with CDS/CDI for documentation queries and criteria clarification.
• Develop and apply clinical guidelines, order sets and care pathways.
• Participate in Utilization Review Committee and related performance improvement activities.

Skills

Medical Leadership

Clinical Review

Healthcare Quality

Communication

Regulatory Knowledge

Education

Doctorate of Medicine (MD)

Board Certification (Preferred)

Job description

Wellstar Health System, Inc. is seeking a Physician Advisor for Wellstar Douglas Hospital to enhance quality, utilization and patient satisfaction through Performance Improvement initiatives and medical education.

The PA will review cases for medical necessity, advise on appropriate levels of care, and collaborate with care teams to optimize outcomes. The role emphasizes readmission reduction, denial management, and development of evidence-based guidelines, requiring leadership, clinical