Physician Advisor: Utilization & Quality Strategy

AdventHealth; Town of Florida (NY); On-site; USD 207,000 - 413,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Life Insurance

Disability Insurance

Paid time off from day one

403-B retirement plan

Parental leave

Career development

Well-being resources

Mental health resources

Pet benefits

Job summary

AdventHealth in Altamonte Springs, FL is seeking a Physician Advisor to educate and advise Utilization Management, HIM, Revenue Cycle, Patient Access, Managed Care teams on updates and trends related to utilization and denial prevention.

The role provides physician‑level review of utilization, claims management, and quality assurance for inpatient, outpatient/observation, and referral services. It serves as a key clinical liaison and helps promote high‑quality, cost‑effective care.

Qualifications

• MD or DO with active medical license and board certification.
• 5+ years of recent clinical practice experience.
• 2+ years or greater as Physician Advisor (preferred).
• 3+ years of leadership experience (preferred).
• Strong communication, analytical, and problem‑solving abilities.
• Ability to work in a matrix‑management environment and educate staff.

Responsibilities

• Reviews and authorizes inpatient days, evaluates utilization patterns, and ensures appropriate determinations.
• Collaborates with Utilization Management on case reviews and process improvements.
• Acts as clinical liaison with attending physicians and medical staff for decision‑making and documentation.
• Partners with managed care payers on denials, appeals, and utilization criteria.
• Analyzes data to identify utilization improvements and monitor outliers.
• Educates physicians and clinical teams on UM protocols and regulatory changes.
• Reviews payer denials and supports denial prevention strategies.
• Participates in Utilization Management and hospital committees, supporting quality initiatives.
• Supports organizational goals for length of stay, quality, and resource stewardship.
• Performs other duties as assigned.

Skills

Relationship building

Clinical practice

Organization

Analytical skills

Communication

Matrix management

Policy interpretation

Medical advice

Microsoft Office

Health plan experience

Education

Doctorate

Master's degree (preferred)

Tools

Outlook

Word

Excel

PowerPoint

Job description

AdventHealth in Altamonte Springs, FL is seeking a Physician Advisor to educate and advise Utilization Management, HIM, Revenue Cycle, Patient Access, Managed Care teams on updates and trends related to utilization and denial prevention.

The role provides physician‑level review of utilization, claims management, and quality assurance for inpatient, outpatient/observation, and referral services. It serves as a key clinical liaison and helps promote high‑quality, cost‑effective care.