Lead Physician Advisor - Centralized Utilization Review - FT Days - MHS at Memorial Healthcare

Killingly, Connecticut, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Jan, 26

Salary

0.0

Posted On

12 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Judgment, Utilization Management, Payer Policies, Leadership, Documentation, Medical Necessity, Compliance Standards, Process Improvement, Education, Provider Engagement, Peer Review, Discharge Planning, Denial Prevention, Team Leadership, Strategic Execution, Performance Monitoring

Industry

Hospitals and Health Care

Description

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: The Physician Advisor Lead serves as the clinical and operational leader for the physician advisor team, guiding the strategic execution of utilization review, medical necessity compliance, and care optimization initiatives across the hospital system. This position combines direct clinical support with team leadership responsibilities, ensuring alignment with CMS regulations, efficient throughput, and denial prevention. The Lead partners closely with Case Management (CM), Utilization Review (UR), Coding, and Executive Leadership to monitor and improve system performance in key utilization metrics. Responsibilities: Clinical Operations: Performs secondary reviews for level of care determinations, including inpatient vs. observation and continued stay. Conducts peer to peer conversations with payer medical directors to address concurrent denials and avoid revenue loss. Serves as the clinical bridge between hospitalist providers and administrative teams for utilization efficiency.Process Improvement and Strategic Support: Identifies patterns in denials, or documentation gaps and lead corrective action planning. Collaborates with leadership in UR, CM, and CDI to ensure workflows are aligned for efficient discharge planning and accurate status assignment. Participates in denial prevention workgroups, length of stay (LOS) reduction committees, and multidisciplinary rounds.Education and Provider Engagement: Leads provider education on medical necessity, documentation, and regulatory compliance. Develops and disseminates guidance tools, clinical pathways, and feedback to hospitalist teams and specialists.Leadership and Oversight: Provides direct leadership to the physician advisor team, ensuring consistency in medical necessity reviews, payer interactions, and documentation education. Ensures consistency with established workflows and assigns, monitors, and oversees physician advisor case reviews as applicable to ensure timely completion and high-quality determinations. Serves as the escalation point for complex reviews, payer disputes, and provider engagement concerns. Facilitates onboarding, training, and performance feedback for physician advisors. Competencies: Education and Certification Requirements: Medical Doctor (Required)Medical Doctor License (ME LICENSE) - State of Florida (FL), Osteopathic Physician License (OS LICENSE) - State of Florida (FL) Additional Job Information: Complexity of Work: This role requires exceptional clinical judgment, a deep understanding of utilization management and payer policies, and the ability to lead both through influence and formal leadership. The Physician Advisor Lead must be able to manage sensitive provider relationships, ensure adherence to compliance standards, and drive system wide process improvements in a dynamic hospital environment. Required Work Experience: Minimum of three (3) years’ clinical practice. At least, two (2) years’ experience as a physician advisor or in a similar utilization management leadership role preferred. Other Information: Other Certification Info: Board certification in a clinical specialty required. Certification or formal training in Utilization Review or Physician Advisor practice (e.g., CHCQM, ABQAURP) strongly preferred. Working Conditions and Physical Requirements: Bending and Stooping = 60% Climbing = 40% Keyboard Entry = 100% Kneeling = 40% Lifting/Carrying Patients 35 Pounds or Greater = 0% Lifting or Carrying 0 - 25 lbs Non-Patient = 60% Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0% Lifting or Carrying > 75 lbs Non-Patient = 0% Pushing or Pulling 0 - 25 lbs Non-Patient = 60% Pushing or Pulling 26 - 75 lbs Non-Patient = 0% Pushing or Pulling > 75 lbs Non-Patient = 0% Reaching = 60% Repetitive Movement Foot/Leg = 40% Repetitive Movement Hand/Arm = 100% Running = 0% Sitting = 100% Squatting = 80% Standing = 80% Walking = 80% Audible Speech = 100% Hearing Acuity = 100% Smelling Acuity = 0% Taste Discrimination = 0% Depth Perception = 60% Distinguish Color = 60% Seeing - Far = 60% Seeing - Near = 60% Bio hazardous Waste = 40% Biological Hazards - Respiratory = 0% Biological Hazards - Skin or Ingestion = 0% Blood and/or Bodily Fluids = 40% Communicable Diseases and/or Pathogens = 0% Asbestos = 0% Cytotoxic Chemicals = 0% Dust = 0% Gas/Vapors/Fumes = 0% Hazardous Chemicals = 0% Hazardous Medication = 0% Latex = 0% Computer Monitor = 80% Domestic Animals = 40% Extreme Heat/Cold = 40% Fire Risk = 0% Hazardous Noise = 0% Heating Devices = 0% Hypoxia = 0% Laser/High Intensity Lights = 0% Magnetic Fields = 0% Moving Mechanical Parts = 0% Needles/Sharp Objects = 0% Potential Electric Shock = 0% Potential for Physical Assault = 40% Radiation = 0% Sudden Decompression During Flights = 0% Unprotected Heights = 0% Wet or Slippery Surfaces = 0% Shift: Primarily for office workers - not eligible for shift differential Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net Be where care matters. At Memorial Healthcare System, we are dedicated to improving the health, well-being, and quality of life of the people entrusted to our care. This unwavering commitment to our service vision makes the difference and is the foundation of The Memorial Experience. Deeper Caring. Smarter Healthcare. Talk to our patients and their families about “Deeper Caring,” and they'll tell you stories about miracle babies, lives saved through sheer determination, and the comforting kindness of others. About people who advocated for the family’s best interests and cared for them in body, mind, and spirit. For our employees, “Smarter Healthcare” means constantly improving how we deliver care. It could be a new technology, a streamlined process, or a cutting-edge program leveraging our system strengths. But, no matter how you look at it, our service vision is integral to our culture today and what we strive to be tomorrow. We invite you to share in the Memorial Experience – where touching lives, lifting spirits, and healing the human body is our profession’s greatest privilege and reward. Be where you are valued. Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job. Who is eligible for Veteran’s Preference? We are proud to offer preference to internal and external applicants who identify within these categories: veterans, disabled veterans, spouse of a disabled veteran, unremarried veteran widow/widower, certain family members, active reservists and members of the National Guard. What should I do if I am eligible for Veteran’s Preference? You must claim your Veteran’s Preference status on your application. If selected for a job, you must provide documentation regarding your status. How does Memorial verify that someone is eligible for Veteran’s Preference? We require specific documentation as determined by the basis for which someone claims preference. For example, the documentation for a disabled veteran is different from the documentation required for the spouse of a veteran killed in the line of duty. How often can an eligible person claim Veteran's Preference at Memorial? There is no limit to how often internal or external applicants can use preference when a job is posted externally on our career website or elsewhere. What if there are two equally qualified, preference-eligible job applicants? In this case, the selection is based on the eligibility category in accordance with Florida law. First preference is given to: An honorably discharged veteran who has served on active duty and has a service-connected, compensable disability. A spouse of a person who has a total, permanent, service-connected disability and cannot qualify for employment. A spouse of a person missing in action, captured or forcibly detained or interned by a foreign government or power. What do I do if I am denied Veteran's Preference? If you feel you have been unfairly denied Veteran’s Preference by Memorial Healthcare System, please contact EmployeeRelations@mhs.net. You may also file a complaint with the Florida Department of Veterans’ Affairs (FDVA). By clicking on any of the following links, you will be leaving the Memorial career site to go to a third party site. Please note that we are not responsible for the content or accessibility of the PDF documents you download from that site. All of the links in this section will download PDFs that require Adobe Reader or compatible software to open and read the documents. If you need Adobe Reader, you can download it now. Florida Civil Rights Act Equal Employment Opportunity is the Law (EEO) Family and Medical Leave Act (FMLA) Employee Polygraph Protection Act (EPPA) E-Verify™ Participation Notice – English Right To Work Notice – English E-Verify™ Participation Notice – Spanish Right To Work Notice – Spanish Memorial Healthcare System is subject to the Florida Public Records Law. All information provided in connection with your application for employment will be a public record and subject to release upon request, unless considered exempt or confidential.

Responsibilities

The Physician Advisor Lead serves as the clinical and operational leader for the physician advisor team, guiding the strategic execution of utilization review and care optimization initiatives. This position combines direct clinical support with team leadership responsibilities to ensure compliance and efficient throughput.