Senior Physician Advisor & Utilization Lead

Med-Metrix, LLC; Philadelphia (Philadelphia County); Remote; USD 130,000 - 190,000; Full time

Job summary

Med-Metrix, LLC, a physician advisory services organization, seeks a Physician Advisor II to lead clinical reviews, mentor internal staff, and maintain high-quality utilization management for multiple client programs. You will collaborate with medical leadership to optimize resource use and ensure compliant, evidence-based patient care across services.

The role emphasizes reviewing complex cases, improving documentation for accuracy in coding and DRG assignments, and participating in ongoing

Qualifications

• Specialty Board Certified.
• Licensed to practice medicine in the US.
• 3+ years as a Physician Advisor or UR/UM Medical Director performing case reviews.
• Basic technical skills with EMRs and Microsoft Office/Teams.
• Unrestricted medical license and Board Certification.
• Knowledge of utilization management, quality improvement, and patient safety.

Responsibilities

• Responds to requests for assistance on clinical reviews for medical necessity or other reasons by Case Management.
• Provides consultation to attendings, nurses, and staff on complex clinical issues and justification for continued stay.
• Applies standard criteria (MCG/InterQual) with clinical judgment.
• Maintains accountability for case management outcomes and supports clinical progression of patient care.
• Suggests improvements in health record documentation for ICD coding and DRG assignment.
• Participates in ongoing training and education related to Utilization Management and Care Management.
• Meets production standards and quality expectations.
• Maintains confidentiality of patient care and business matters.
• Leads education for client facilities and mentors other Physician Advisors.
• Supports PAOC quality programs and dashboard management.

Skills

Clinical expertise

Leadership

Communication

Mentoring

Problem solving

Education

MD/DO

Board Certification

Medical license in US

Tools

EMR systems

Microsoft Office/Teams

Job description

Med-Metrix, LLC, a physician advisory services organization, seeks a Physician Advisor II to lead clinical reviews, mentor internal staff, and maintain high-quality utilization management for multiple client programs. You will collaborate with medical leadership to optimize resource use and ensure compliant, evidence-based patient care across services.

The role emphasizes reviewing complex cases, improving documentation for accuracy in coding and DRG assignments, and participating in ongoing