PHYSICIAN ADVISOR-UTILIZATION MANAGEMENT

Job Description

Summary: The Physician Advisor serves as a liaison among physicians, Utilization Management (UM), Clinical Documentation Integrity (CDI), and hospital administration. This role involves advising on best practices, staying updated on payer rules and regulations, and ensuring excellent customer service aligned with the organization’s values.

Responsibilities:

• Manage denial queues and conduct peer-to-peer discussions with payers.
• Perform medical necessity reviews and maintain work queues.
• Assist in CDI/UM education and provide feedback to medical staff.
• Collaborate on CDI denials and develop educational content.
• Participate in Utilization Management Committee meetings and stay current on regulatory changes.

Education/Experience Requirements:

• Graduate of an accredited medical school and current Michigan medical license.
• Completion of a specialty residency and at least 3 years in a hospital-based practice.
• Board certification preferred.

Knowledge/Skills/Abilities:

• Strong relationship-building and communication skills.
• Ability to prioritize tasks and meet deadlines.
• Proficient in computer applications and healthcare reimbursement issues.

Working Conditions: Regular attendance required; physical demands include sitting, standing, and lifting.

Job Type: Full-time, Day shift, with a pay range of $96.72 – $137.03 per hour and various benefits.