Physician Advisor

The Physician Advisor serves as a physician leader partnering with Care Management, Utilization Management (UM), Clinical Documentation Improvement (CDI), Health Information Management (HIM), Revenue Cycle, Quality, and clinical service lines to ensure medically appropriate, timely, and accurately documented care. This role provides expert clinical review, peer-to-peer consultation, and physician-to-physician communication to support correct patient status determination, level of care, and regulatory compliance. The Physician Advisor strengthens clinical documentation and severity capture, supports denial prevention and appeals, and advances quality and throughput initiatives while promoting a culture of collaboration and evidence-based practice.

• Provide physician oversight for medical necessity, admission status, continued stay, and level-of-care decisions in partnership with Utilization Management and Care Management.
• Perform concurrent review of high-risk or complex cases, support payer peer-to-peer discussions, and ensure documentation supports medical necessity.
• Advance timely progression of care by addressing discharge barriers, reducing avoidable days, and promoting consistent InterQual use across service lines.
• Partner with Revenue Cycle and denials teams to prevent avoidable denials through early intervention, physician education, and feedback on documentation and order patterns.
• Review adverse determinations, support appeals with strong clinical narratives and evidence, and use denial trends to drive corrective action plans.
• Serve as the physician champion for CDI by improving documentation accuracy, specificity, severity capture, and appropriate DRG assignment.
• Work with CDI, HIM, and Coding to close documentation gaps in real time, support clinical validation, and prevent DRG downgrades.
• Educate providers on best-practice documentation, including diagnosis specificity, linkage to clinical indicators, treatment rationale, and POA/HAC considerations.
• Align documentation improvement with quality, patient safety, risk adjustment, public reporting, and value-based performance goals.
• Support regulatory and accreditation compliance, promote evidence-based care pathways, reduce variation, and identify opportunities to improve LOS, readmissions, complications, and patient flow.
• Build strong interdisciplinary partnerships, provide timely and collegial consultation, participate in rounds and escalation huddles, and represent the organization in key committees and workgroups.
• Use dashboards and performance metrics such as denials, observation utilization, LOS, readmissions, CDI response rates, SOI/ROM, and CC/MCC capture to prioritize interventions and evaluate results.

Education

MD or DO - Required

Work Experience:

• Current clinical experience in acute care (or relevant recent experience) - Required
• Five years post residency as attending physician - Required
• Strong understanding of medical necessity, payer rules, and documentation standards (or demonstrated ability to learn quickly) - Required
• Excellent communication skills for physician-to-physician discussions and interdisciplinary collaboration - Required
• Prior experience as a Physician Advisor, Medical Director, Hospitalist leader, UM physician, CDI physician champion, or similar role - Preferred
• Familiarity with InterQual criteria and denial/appeal workflow - Preferred
• Experience with CDI, clinical validation, risk adjustment, and documentation education - Preferred Knowledge of CMS regulations, Conditions of Participation, and value-based program - Preferred

Licenses and Certifications

• Active (or eligible) Missouri medical license - Required
• Board certified or board eligible in a relevant specialty (e.g., Internal Medicine, Family Medicine, Hospital Medicine) - Required