Physician Advisor - Penn Medicine

As a key member of the healthcare organization's leadership team, the Physician Advisor supports the appropriate utilization of healthcare resources through clinical expertise in medical necessity, patient status, levels of care, physician documentation, utilization review, denial management, and regulatory compliance. Working collaboratively with physicians, case management, utilization review, social services, discharge planning, and hospital leadership, this role helps optimize patient care while ensuring compliance with governmental and commercial payer requirements.

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Position Description:

Penn Medicine is seeking a collaborative and experienced Physician Advisor to join our physician leadership team. This is a remote position offering the opportunity to partner with hospital leadership, medical staff, and care management teams to promote high-quality, efficient, and compliant patient care through effective utilization management and physician engagement.

As a key member of the healthcare organization's leadership team, the Physician Advisor supports the appropriate utilization of healthcare resources through clinical expertise in medical necessity, patient status, levels of care, physician documentation, utilization review, denial management, and regulatory compliance. Working collaboratively with physicians, case management, utilization review, social services, discharge planning, and hospital leadership, this role helps optimize patient care while ensuring compliance with governmental and commercial payer requirements.

Key Responsibilities:

• Provide guidance on appropriate patient status, medical necessity, and level of care, including secondary reviews and observation cases.
• Support utilization review and denial management activities, including peer-to-peer discussions and appeals with third-party payers.
• Ensure compliance with Medicare, CMS, commercial payer regulations, and the Two-Midnight Rule.
• Collaborate with physicians, case management, and hospital leadership to improve documentation, care progression, and appropriate resource utilization.
• Utilize InterQual® or other approved criteria to support clinical decision-making and level of care recommendations.
• Educate physicians and care management teams on documentation standards, utilization management, and payer requirements.
• Identify opportunities to improve denial prevention, documentation quality, and utilization practices.
• Participate in utilization management committees and perform duties in accordance with Penn Medicine values, policies, and procedures.

Position Requirements:

• Graduate of an accredited School of Medicine (Allopathic/Osteopathic)
• Possess or able to obtain an unrestricted PA Medical License
• Board Eligible or Board Certified
• Minimum 5 years’ clinical experience in a hospital setting (required)
• Possess or develop a solid foundation in the areas of utilization management and hospital operations (required)
• Master of Business Administration (MBA), Master of Medical Management (MMM), or similar degree (preferred)
• American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Health Care Quality and Management (HCQM) certification (preferred)
• American College of Physician Advisors certification (ACPA-C) (preferred)

Additional Information: Interested candidates may apply online or send CV and cover letter to Ashleigh Cole, Manager - Provider Recruitment at Ashleigh.Cole@pennmedicine.upenn.edu

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.