Senior Physician Utilization & Denials Advisor

ACPM; United States; Hybrid; USD 250,000 - 350,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Paid malpractice insurance

Paid Time Off

Retirement plan

Job summary

MedStar Health seeks a Physician Advisor to join a hybrid role supporting hospitals across the system. The physician will optimize resource use, reduce length of stay, and prevent clinical denials, working with case management and hospital leaders to ensure timely, appropriate care.

Qualifications include MD/DO with board certification and 5+ years clinical experience; familiarity with MCG and InterQual criteria is preferred. Salary range USD 250,000–350,000 per year plus comprehensive benefits.

Qualifications

• MD or DO with board certification required.
• ACPA-C or ABQUARP certification preferred or willingness to obtain within 1 year.

Responsibilities

• Review patient status, medical necessity, and level of care.
• Lead clinical denial interventions and denial root cause determinations.
• Engage in concurrent and retrospective denials management and payer discussions.
• Drive length of stay improvements with case management and hospital stakeholders.
• Educate physicians on regulatory requirements and appropriate utilization of hospital services.

Skills

Clinical practice

Denials management

Utilization review

Regulatory knowledge

Education

MD/DO; Board Certified

ACPA-C or ABQUARP preferred

Tools

MCG criteria

InterQual criteria

Job description

MedStar Health seeks a Physician Advisor to join a hybrid role supporting hospitals across the system. The physician will optimize resource use, reduce length of stay, and prevent clinical denials, working with case management and hospital leaders to ensure timely, appropriate care.

Qualifications include MD/DO with board certification and 5+ years clinical experience; familiarity with MCG and InterQual criteria is preferred. Salary range USD 250,000–350,000 per year plus comprehensive benefits.