Senior Physician Advisor — Utilization Management

Penn Medicine; Bala Cynwyd (PA); Hybrid; USD 150.000 - 210.000; Vollzeit

Zusammenfassung

Penn Medicine, a leading academic medical center, seeks a Physician Advisor to provide clinical leadership within Utilization Management and to support appropriate patient status determinations, medical necessity review, and regulatory compliance. The role centers on clinical consultation, education, and collaboration with interdisciplinary teams to optimize care progression and resource use.

Working in a hybrid environment at HUP/Corporate Services, the physician will contribute to performance

Qualifikationen

• MD/DO degree required and licensed in PA.
• Minimum 5 years of clinical hospital experience.
• At least 3 years of IT knowledge including EMR documentation and medical informatics.
• Solid foundation in utilization management and hospital operations.

Aufgaben

• Provide clinical oversight and consultation on admission status and level of care.
• Support medical necessity reviews and regulatory payer requirements.
• Assist in peer discussions, denial prevention, and appeal support.
• Educate physicians and UM/CM teams on documentation standards and criteria.
• Collaborate across Case Management, Social Work, CDI, Coding, HIM, Revenue Cycle, and operations.
• Identify trends in denials and utilization patterns to guide improvement initiatives.
• Participate in projects and organizational initiatives while upholding Penn Medicine values.
• Other duties to support the unit and health system.

Ausbildung

MD/DO required

Hosp clinical experience 5+ years

IT/EMR knowledge 3+ yrs

Utilization management/ hospital operations

Jobbeschreibung

Penn Medicine, a leading academic medical center, seeks a Physician Advisor to provide clinical leadership within Utilization Management and to support appropriate patient status determinations, medical necessity review, and regulatory compliance. The role centers on clinical consultation, education, and collaboration with interdisciplinary teams to optimize care progression and resource use.

Working in a hybrid environment at HUP/Corporate Services, the physician will contribute to performance