Senior Physician Advisor — Utilization & Quality Leader

Med-Metrix; Philadelphia (Philadelphia County); On-site; USD 120,000 - 180,000; Full time

Job summary

Med-Metrix seeks a Physician Advisor II to lead clinical reviews and mentor teams across patient care pathways. You will work closely with medical staff leadership to optimize utilization, ensure medical necessity, and improve documentation for accurate coding and DRG assignment.

Responsibilities include advising on complex cases, applying InterQual/MCG criteria, and supporting continuous PA development while maintaining licensure and board certification.

Qualifications

• Specialty Board Certified
• Licensed to practice medicine in the US
• 3+ years as Physician Advisor or UR/UM Medical Director performing case reviews
• Basic technical skills with Hospital EMRs and Microsoft Office and Teams
• Solid foundation in utilization management, quality improvement, and patient safety
• Working knowledge of hospital organization, case management operations and policies
• ACPA/ABQAURP certifications preferred
• Proficiency in Microsoft Office Suite
• Strong communication and judgment skills

Responsibilities

• Responds to requests for clinical reviews in a timely fashion
• Consults with attendings, nurses, and case management on complex issues
• Applies published criteria (MCG/InterQual) with professional judgment
• Achieves case management outcomes and supports clinical progression
• Improves health record documentation for accurate ICD coding and DRG assignment
• Participates in training related to Utilization Management and Care Management
• Meets production standards and quality goals
• Maintains patient confidentiality and HIPAA compliance
• Mentors physicians and leads dashboard management for PAOC
• Maintains licensure and board certification

Skills

Physician Advisor

Clinical leadership

Utilization management

Quality improvement

HIPAA compliance

Tools

Hospital EMRs

Microsoft Office

Microsoft Teams

Job description

Med-Metrix seeks a Physician Advisor II to lead clinical reviews and mentor teams across patient care pathways. You will work closely with medical staff leadership to optimize utilization, ensure medical necessity, and improve documentation for accurate coding and DRG assignment.

Responsibilities include advising on complex cases, applying InterQual/MCG criteria, and supporting continuous PA development while maintaining licensure and board certification.