Review admissions, continued stays, observations, and readmissions for medical necessity and compliance.
Apply the Two-Midnight Rule, payer guidelines, and manage denials and appeals.
Educate providers on documentation, patient status, and utilization management processes.
Participate in utilization management committees and escalate non-compliance trends.
Collaborate with leadership and care teams to optimize patient flow, length of stay, and quality outcomes.
Recommend evidence-based care coordination steps and support quality improvement initiatives.
Maintain compliance with CMS and regulatory standards.
Present to medical staff or administration and perform additional duties as assigned.
Role and Responsibilities of the Physician Advisor
The Physician Advisor (PA) is a clinical leader responsible for ensuring appropriate patient care, optimizing resource utilization, and maintaining regulatory compliance.
The PA conducts medical necessity and utilization reviews, manages denials and appeals, advises providers on patient status and documentation, and collaborates with Care Management and hospital leadership to improve throughput, length of stay, and overall quality outcomes.
Work Schedule and Availability
The Physician Advisor works primarily Monday-Friday, 8:00 AM - 4:00 PM, with occasional off-hours or weekend coverage as needed to support the Utilization Management program.