Senior Physician Utilization Leader

Wellstar Health System, Inc.; Georgia; On-site; USD 150,000 - 210,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Physician Advisor to report to the Chief Medical Officer and drive quality, utilization, patient satisfaction, and efficiency through performance improvement and education initiatives across Wellstar facilities.

The role involves clinical review of cases for commercial payers and Medicare Advantage, ensuring medical necessity, appropriate level of care, and alignment with pathway standards.

Qualifications

• Requires Doctorate of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
• Board certification in specialty preferred; active license to practice in Georgia.
• 8–10 years of clinical experience with 1–3 years in Utilization Management or related force.

Responsibilities

• Perform clinical reviews for care justification and appropriate level of care.
• Lead readmission reduction efforts with hospital leadership.
• Provide education and expert consultation to Care Coordination and administration.
• Review documentation for medical necessity and coding accuracy.
• Participate in Hospital-wide performance improvement and utilization committees.
• Support on-call activities and real-time physician consultation.

Skills

Communication skills

English proficiency

Leadership

Organizational skills

Education

MD/DO

MBA/MPH preferred

Job description

Wellstar Health System, Inc. is seeking a Physician Advisor to report to the Chief Medical Officer and drive quality, utilization, patient satisfaction, and efficiency through performance improvement and education initiatives across Wellstar facilities.

The role involves clinical review of cases for commercial payers and Medicare Advantage, ensuring medical necessity, appropriate level of care, and alignment with pathway standards.