Physician Advisor, Quality Utilization Management
This role involves providing clinical and management guidance to optimize resource utilization and improve healthcare quality at the hospital level. Responsibilities include supporting care coordination, leading UM committees, educating staff on clinical documentation and medical necessity, and promoting evidence-based practices. The physician collaborates with clinical teams, hospital leadership, and payors to monitor patient care, reduce unnecessary tests, and address delays. Key duties include attending rounds, analyzing payer trends, managing denials, and implementing process improvements aligned with regulatory standards. Qualifications include a minimum of five years of clinical practice, strong leadership and communication skills, and licensure as a licensed, board-certified physician. Preferred candidates have experience in utilization management, committee participation, and membership in professional organizations. The role emphasizes collaboration, strategic planning, and adherence to best practices to enhance care delivery and operational efficiency.