Lead Physician Advisor - Centralized Utilization Review - FT Days - MHS

Lead Physician Advisor - Centralized Utilization Review - FT Days - MHS

Location: Miramar, Florida

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

Perform secondary reviews for level of care determinations, including inpatient vs. observation and continued stay.

Conduct peer-to-peer conversations with payer medical directors to address concurrent denials and avoid revenue loss.

Serve as the clinical bridge between hospitalist providers and administrative teams for utilization efficiency.

Identify patterns in denials or documentation gaps and lead corrective action planning.

Collaborate with leadership in UR, CM, and CDI to ensure workflows are aligned for efficient discharge planning and accurate status assignment.

Participate in denial prevention workgroups, length of stay (LOS) reduction committees, and multidisciplinary rounds.

Lead provider education on medical necessity, documentation, and regulatory compliance.

Develop and disseminate guidance tools, clinical pathways, and feedback to hospitalist teams and specialists.

Provide direct leadership to the physician advisor team, ensuring consistency in medical necessity reviews, payer interactions, and documentation education.

Monitor and oversee physician advisor case reviews to ensure timely completion and high-quality determinations.

Serve as the escalation point for complex reviews, payer disputes, and provider engagement concerns.

Facilitate onboarding, training, and performance feedback for physician advisors.

Education and certification requirements

Medical Doctor (required)

Medical Doctor License – State of Florida (FL)

Osteopathic Physician License – State of Florida (FL)

Board certification in a clinical specialty (required)

Certification or formal training in Utilization Review or Physician Advisor practice (e.g., CHCQM, ABQAURP) strongly preferred

Qualifications

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.

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 25-75 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

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