PA Licensed Physician Advisor

Job Summary

Providing clinical leadership in Utilization Management, the full-time PA Licensed Physician Advisor will conduct medical necessity reviews, support patient status determinations, and collaborate with interdisciplinary teams remotely to enhance patient outcomes and operational efficiency.

Key responsibilities:

• Provide clinical oversight and consultation on admission status, level of care, and regulatory compliance
• Conduct secondary reviews and participate in peer-to-peer discussions to resolve complex cases and prevent denials
• Educate medical staff on documentation standards and collaborate with various departments to improve care progression and reimbursement accuracy

Required qualifications:

• Must be a PA State Licensed Medical Doctor or Doctor of Osteopathic Medicine
• MD or DO is required
• 5+ years of clinical experience in a hospital setting
• 3+ years of knowledge in information technology, including statistical analysis and clinical protocols
• Solid foundation in utilization management and hospital operations