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Part Time Physician Advisor - Pittsburgh, PA

Highmark Inc

  • Monroeville, PA
  • 1 day ago

    Highlights

    Working closely with physicians, case management, utilization management, nursing, coding, clinical documentation, and hospital leadership, the Physician Advisor also contributes to quality and patient-throughput initiatives and serves as an active member of the Utilization Management Committee. Within AHN East, this Physician Advisor supports both Forbes Hospital and Allegheny Valley Hospital while working with site leaders and network partners to advance shared quality, utilization, and patient-flow priorities.
    Highmark Inc

    Numbers & Facts

    LocationMonroeville, PA
    IndustryHealthcare Services
    Company Size1,000 to 1,499 employees
    Year Founded1996
    Websitehttps://www.highmark.com/hmk2/index.shtml

    Description

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    Part Time Physician Advisor - Pittsburgh, PA

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    Part Time Physician Advisor - Pittsburgh, PA

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    2566 Haymaker Rd, Monroeville PA 15146, United States

    Company :

    Allegheny Health Network

    Job Description :

    Role Overview

    AHN's regional model aligns hospitals within defined geographic markets to strengthen local leadership, operational coordination, and access to consistent network resources and standards. Within AHN East, this Physician Advisor supports both Forbes Hospital and Allegheny Valley Hospital while working with site leaders and network partners to advance shared quality, utilization, and patient-flow priorities.

    The Physician Advisor promotes clinically appropriate, cost-effective care by aligning patient needs with regulatory and payer requirements for medical necessity, level of care, and care setting. The role performs level-of-care reviews, supports denial prevention and appeals, and conducts peer-to-peer discussions with payer medical directors. Working closely with physicians, case management, utilization management, nursing, coding, clinical documentation, and hospital leadership, the Physician Advisor also contributes to quality and patient-throughput initiatives and serves as an active member of the Utilization Management Committee. The position reports to the Chief Quality Officer and the Medical Director of Physician Advisors.

    Key Responsibilities

    • Maintain a regular onsite presence primarily at Forbes Hospital within a hybrid work model, with intermittent presence at Allegheny Valley Hospital focused largely on education and engagement with hospital executive leadership.
    • Review admissions, observation services, continued stays, and ancillary services for medical necessity, level-of-care accuracy, and appropriate care setting.
    • Collaborate with attending physicians, case managers, utilization management nurses, nursing leaders, and hospital leadership to resolve complex cases and support timely care progression.
    • Conduct peer-to-peer discussions with payer medical directors and support authorization, denial prevention, and appeal activities.
    • Monitor observation cases, communicate status recommendations, and facilitate established escalation and review processes.
    • Participate in interdisciplinary rounds to improve quality, care coordination, throughput, and length of stay.
    • Provide clinical expertise and education to medical staff, residents, case management, and utilization management teams on medical necessity, documentation, observation status, and payer requirements.
    • Partner with coding and clinical documentation specialists to strengthen documentation accuracy and support appropriate reimbursement.
    • Serve as an active member of the Utilization Management Committee and provide physician leadership for case management, observation, and throughput priorities.
    • Review performance dashboards, identify trends, and lead action plans when utilization or throughput goals are not met.

    Qualifications

    Required

    • MD or DO degree.
    • Board certification in a medical specialty or subspecialty.
    • At least five years of clinical practice experience in a hospital setting.
    • Eligibility for an unrestricted Pennsylvania medical license, with licensure required before employment.
    • Ability to obtain and maintain medical staff credentials within Allegheny Health Network.

    Preferred

    • Certification or advanced training in physician advising, healthcare quality, or utilization management.
    • Experience as a Physician Advisor in an acute-care setting.
    • Experience leading cross-functional work within a large health system.
    • Experience working within an integrated payer-provider organization.

    Apply or Learn More

    Carissa Johnston | Physician Recruiter

    Carissa.Johnston@ahn.org | 412-527-5941

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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    Job Details

    • Job category Physician
    • Position Type Part Time
    • Posted 10/26/2026
    • Location(s) 2566 Haymaker Rd, Monroeville PA 15146, United States
    • Line of Business
    • Entity
    • Recruiter
    • Hiring Manager
    • Experience Level
    • Job Family Physician-AHN
    • Req ID J288516

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    Highmark Health is an independent licensee of the Blue Cross Blue Shield Association.

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

    We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

    We provide reasonable accommodations to applicants with disabilities or who require accommodations for sincerely held religious beliefs or for known limitations related to pregnancy, childbirth, or related medical conditions. If you need an accommodation, please contact HRServices@highmarkhealth.org. This email is exclusively for accommodation requests under applicable laws.

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    About Company

    Highmark provides millions of people with the security of quality health insurance

    Our history of helping families and companies with their health insurance needs dates to the 1930s, when our predecessor companies were established to help Pennsylvania's residents pay for health care.

    Highmark was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association — Pennsylvania Blue Shield (now Highmark Blue Shield) and Blue Cross of Western Pennsylvania (now Highmark Blue Cross Blue Shield). We are now one of the largest health insurers in the United States.

    Highmark's officers and board of directors set the company's strategic direction and corporate policies. They are guided by our mission, vision and values.

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