Physician Advisor

Job Description

The Physician Advisor serves as a critical bridge between clinical practice and operational excellence, supporting Centra Health’s goals in delivering high-quality, cost-effective, and patient-centered care. This role provides physician leadership across utilization management (UM), clinical documentation integrity (CDI), care progression, regulatory compliance, and performance improvement.

Working collaboratively with clinical teams, operational leaders, and support departments, the Physician Advisor promotes clinical efficiency, drives compliance with CMS guidelines, and enhances overall care coordination.

Key Responsibilities

Leadership and Collaboration

• Serve as the medical director and leader of the Physician Advisor, Clinical Documentation, and Utilization Review teams
• Support the Physician Advisor comprehensive program with scheduling and coverage support, leadership development, and programmatic budgeting
• Define and pursue outcome metrics for the Physician Advisor program
• Act as a trusted clinical advisor, fostering alignment between physicians and operational priorities.
• Lead clinical teams in performance improvement initiatives related to LOS, documentation, throughput, and cost of care.
• Lead and support alignment with system-wide strategies in:
• Inpatient Clinical Optimization
• Clinical Documentation Improvement
• Regulatory Readiness
• Cost-of-Care Management
  
  

Utilization Management

• Review cases to assess medical necessity, appropriate level of care, and length of stay, especially outliers.
• Participate in multidisciplinary rounds to identify and mitigate care progression delays.
• Facilitate peer-to-peer conversations about medical necessity determinations and payer disputes.
• Support throughput efforts by identifying and resolving discharge barriers.
• Provide input on observation status determinations and ensure appropriate clinical documentation.
  
  

Clinical Documentation Integrity (CDI)

• Engage physicians to improve documentation accuracy, specificity, and timeliness.
• Collaborate with CDI and coding teams to address quality metrics influenced by documentation (e.g., PSI-90, SOI/ROM).
• Review query response trends and support escalation or education as needed.
• Provide education to clinicians on CDI principles, DRG optimization, and coding best practices.
  
  

Regulatory & Compliance

• Ensure compliance with CMS Utilization Management requirements, including Conditions of Participation and relevant policies.
• Support the development and implementation of UM plans, committee structures, and documentation workflows that align with federal and state regulations.
• Monitor performance and recommend process improvements for compliance and efficiency.
  
  

Education & Engagement

• Develop and deliver educational sessions to physicians on UM, CDI, documentation standards, and care progression.
• Translate data into actionable insights for clinical teams, connecting administrative and clinical priorities.
• Champion initiatives promote accountability, clinical consistency, and optimal use of hospital resources.
  
  

Strategic Initiatives

• Lead or co-lead initiatives to:
• Optimize LOS and discharge processes
• Reduce readmissions and preventable variation
• Standardize clinical pathways
• Improve use of diagnostics and high-cost therapeutics
• Advance value-based care outcomes
  
  

Qualifications

Education & Certification

• MD or DO with active board certification in a clinical specialty.
• Current license to practice medicine in Virginia.
• Preferred: Certification in healthcare quality or utilization management (e.g., ACMA, CHCQM, ABQAURP).
  
  

Experience

• Minimum 3–5 years of clinical practice experience.
• Prior experience in physician advisor, case management, CDI, or medical leadership roles preferred.
• Strong knowledge of CMS regulations, payer policies, and InterQual/Milliman criteria.
  
  

Skills & Attributes

• Excellent interpersonal and communication skills with the ability to influence and lead across departments.
• Analytical thinker with the ability to interpret data and apply clinical judgment to operational issues.
• Proven ability to drive performance improvement and foster clinician engagement.
• Strong organizational awareness and ability to navigate a complex healthcare environment.