Physician Utilization & Evidence-Based Care Advisor

Med-Metrix; Oregon; Hybrid; USD 150,000 - 230,000; Full time

Job summary

Med-Metrix in Oregon seeks a Physician Advisor to conduct physician-to-physician reviews, provide clinical guidance, and support evidence-based care and appropriate resource utilization. Responsibilities include reviewing medical necessity, assisting utilization review teams, improving documentation for ICD/DRG coding, and applying CMS/MCG guidelines while maintaining HIPAA and security compliance.

Requires an MD/DO license, board certification, and experience in payer or provider-side

Qualifications

• MD or DO with an active, unrestricted medical license.
• US Board Certified in a recognized specialty.
• Minimum 1 year of payor or provider-side utilization review or active ACPA/ABQUARP certification.
• Basic technical skills with hospital EMRs a must.
• Strong knowledge of utilization management, medical necessity and payer regulations.
• Familiarity with MCG/InterQual placement status criteria is preferred.
• ACPA membership preferred.
• Excellent written and verbal communication skills required.

Responsibilities

• Conduct physician-to-physician reviews for medical necessity and level of care.
• Support utilization review and case management with complex clinical decisions.
• Communicate with Physician Advisory team and care staff to promote evidence-based care.
• Assist in improving documentation related to ICD coding, severity of illness, and DRG assignment.
• Keep abreast of CMS and MCG guidelines to enable utilization management decisions.
• Maintain compliance with legal, regulatory and accreditation requirements and payor policies.
• Meet productivity and quality standards within established time requirements.

Skills

Utilization management knowledge

Communication skills

EMR proficiency

Analytical thinking

Education

MD or DO with active license

US Board Certification

ACPA/ABQUARP certification (preferred)

Tools

EMR systems

Microsoft Office

Job description

Med-Metrix in Oregon seeks a Physician Advisor to conduct physician-to-physician reviews, provide clinical guidance, and support evidence-based care and appropriate resource utilization. Responsibilities include reviewing medical necessity, assisting utilization review teams, improving documentation for ICD/DRG coding, and applying CMS/MCG guidelines while maintaining HIPAA and security compliance.

Requires an MD/DO license, board certification, and experience in payer or provider-side