Physician Advisor – Clinical Utilization & Quality Management

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Physician Advisor – Clinical Utilization & Quality Management

Position Overview:

The Physician Advisor (PA) is a vital clinical leader who serves as an expert resource for medical staff, case management, and social work teams, facilitating optimal utilization management and compliance. With a collaborative approach, the PA addresses regulatory compliance, ensures proper documentation for coding accuracy, manages patient care levels, and enhances overall hospital efficiency and patient outcomes. This role has a strategic reporting structure, interfacing closely with Corporate Physician Advisors, Corporate Chief Quality & Information Officers (CQIO), as well as entity-level Chief Medical Officers (CMO) and CEOs.

Benefits:

• Compensation - starting salary can range from $200,652 - $260,000
• Monday - Friday - No Call
• Relocation assistance
• PTO - 1 month, Full Benefits - Health, Dental and Vision

Key Responsibilities:

• Provide clinical expertise to ensure compliance with federal, state, and CMS regulations.

• Evaluate documentation to support accurate coding, medical necessity, and clinical validation.

• Manage patient placement proactively, ensuring appropriate level of care based on medical necessity, severity of illness, and risk of mortality.

• Review and manage hospital utilization, length of stay, and related quality issues.

• Conduct post-discharge audits related to payer compliance and billing accuracy.

• Foster positive relationships and collaborative communication among medical staff, case management, and hospital leadership.

• Identify and implement clinical practice improvements to reduce costs, decrease length of stay, minimize readmissions, and elevate patient care quality.

• Educate medical staff on utilization management principles and compliance best practices.

Qualifications:

• MD or DO required.

• ABQAURP Physician Advisor Sub-Specialty Certification preferred; certification required within one year of hire.

• Minimum of 3 years of clinical practice experience.

• Prior experience conducting clinical case reviews and familiarity with utilization review tools such as MCG or Interqual.

• Comprehensive understanding of CMS guidelines, including the 2 Midnight Rule, Conditions of Participation, and inpatient billing regulations.

• Excellent analytical, organizational, and prioritization skills, with the ability to handle multiple concurrent deadlines.

• Exceptional verbal and written communication skills.

• Demonstrated ability to handle challenging situations professionally and effectively.

• Proficient with relevant healthcare technology and software applications.

• Commitment to ongoing education regarding CMS guidelines, quality improvement, and utilization management.

Position Details:

• Schedule: Monday – Friday (no on-call requirements)

• Previous experience in physician advisor or case management roles strongly preferred.

• Relocation assistance provided.

Join our dedicated healthcare team and leverage your clinical expertise to drive improvements in patient care, compliance, and hospital efficiency.

About MASC Medical

MASC focuses on hands on healthcare staffing with it's strongest associations in the physician staffing & physician recruitment network. MASC wants every client and candidate to receive a personal focus - the desired result that both parties deserve in forming these new relationships. Full House Healthcare Staffing Agency. - Physician Staffing / Physician Recruiter - Mid Level Provider Staffing & Recruitment (Nurse Practitioners & Physician Assistants) - Allied & Other Healthcare Professional Staffing.