Under the direction of the Associate Chief Medical Officer, the Physician Advisor Director provides strategic and operational leadership for the hospital's Physician Advisor Program, supporting Utilization Management (UM), Case Management, Clinical Documentation Integrity (CDI), Revenue Cycle, Population Health, and Quality initiatives. This physician leader serves as the organization's clinical expert in utilization management, patient status determination, denial prevention and appeals, length-of-stay management, care transitions, documentation integrity, and regulatory compliance. The role partners with physicians and operational leaders to improve quality outcomes, patient experience, resource utilization, operational efficiency, and financial performance.
Education:
MD or DO from an accredited medical school.
Additional training in Healthcare Administration, Utilization Management, Clinical Quality, or related disciplines preferred.
Licensures/Certifications:
- Current unrestricted physician license in the State of Maryland.
- Board certified (ABMS or AOA) in any specialty. Internal Medicine, Family Medicine, or Hospital Medicine preferred Experience
- Minimum five years of clinical practice experience.
- Minimum two years of experience in Utilization Management, Physician Advisor, Clinical Quality, Case Management, or related leadership roles.
- Knowledge of value-based care, healthcare reimbursement, payer requirements, and regulatory standards.
Experience:
- 2-4 years of recent experience and expertise in Utilization Management and Clinical Quality Management and 5 years of direct clinical experience.
- Has knowledge of Pay for Performance/VBP initiatives and incentives.
Skills:
- Strong understanding of CMS regulations, utilization review processes, clinical documentation requirements, and denial management.
- Demonstrated leadership, communication, conflict resolution, and change management skills.
- Ability to collaborate effectively with physicians, hospital leadership, Case Management, CDI, HIM, Revenue Cycle, and Quality teams.
- Experience leading physician education and performance improvement initiatives.
Principal Duties and Responsibilities:
- Physician Advisor Program Leadership
- Establish and maintain policies, procedures, and best practices related to utilization management and physician advisor services.
- Provide strategic guidance to hospital leadership regarding resource utilization, patient flow, reimbursement, and regulatory compliance.
- Promote inter-rater reliability and standardized utilization review practices.
- Utilization Management and Patient Status Oversight
- Serve as the physician leader for utilization review activities, including admission appropriateness, level-of-care determinations, inpatient versus observation status, continued stay reviews, length-of-stay management, and care transition planning.
- Partner with Care Management teams to optimize patient throughput, discharge planning, and resource utilization.
- Support efficient utilization management processes across all points of entry into the hospital.
- Denial Prevention and Appeals
- Lead denial prevention, medical necessity review, and payer appeal activities.
- Conduct physician-to-physician discussions and provide oversight of appeal documentation.
- Monitor denial trends, identify root causes, and implement corrective actions to reduce avoidable denials.
- Clinical Documentation, Revenue Cycle, and Physician Engagement
- Partner with CDI, HIM, Case Management, and Revenue Cycle teams to improve documentation accuracy, severity capture, coding integrity, and reimbursement performance.
- Educate physicians and clinical staff regarding utilization management requirements, patient status determination, clinical documentation standards, and reimbursement-related practices.
- Provide performance feedback and educational support to departments and individual physicians as needed.
- Quality, Regulatory, and Accreditation Support
- Maintain expertise in regulatory, accreditation, and payer requirements affecting utilization management and physician advisor functions.
- Participate in regulatory audits, accreditation surveys, and performance improvement initiatives.
- Identify compliance risks and collaborate with operational leaders to implement corrective action plans.
- Committee and Organizational Leadership
- Chair the Utilization Management Medical Staff Committee.
- Represent the hospital in interactions with payers, regulatory agencies, and external organizations related to utilization management and denial prevention.
- Assist in resolving physician and interdisciplinary team conflicts involving utilization management or patient status concerns.
- Support strategic planning and performance improvement initiatives across Care Management, Utilization Review, CDI, and related services.
- Organizational Values
- Demonstrates and promotes GBMC values of:
- Respect: Treats others with dignity, courtesy, and compassion.
- Excellence: Pursues continuous improvement and superior performance.
- Accountability: Takes ownership of results and acts with professionalism.
- Teamwork: Collaborates effectively and fosters positive working relationships.
- Ethical Behavior: Demonstrates integrity and commitment to patient-centered care.
- Results: Achieves measurable outcomes that support organizational goals.
All roles must demonstrate GBMC Values:
Growth
Committed to continuous development that advances excellence, innovation, and the future of healthcare.
- Embraces change and improvement in the work environment
- Continuously seeks to improve the quality of products/services
Respect
Professional, courteous, and ethical — fostering a healing environment with honesty and integrity.
- Demonstrates honesty, integrity and good judgment
- Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers
Excellence
Superior, patient-centered performance in every aspect of the work, celebrating others' accomplishments.
- Displays flexibility in dealing with new situations or obstacles
- Achieves results on time by focusing on priorities and manages time efficiently
Accountability
I Setting goals, measuring outcomes, taking ownership, and protecting patients and colleagues alike.
- Sets a positive, professional example for others
- Takes ownership of problems and does what is needed to solve them
- Appropriately plans and utilizes required resources for various job duties
- Reports to work regularly and on time
Teamwork
Engaged and collaborative — keeping people informed and helping educate the next generation..
- Works cooperatively and collaboratively with others for the success of the team
- Addresses and resolves conflict in a positive way
- Seeks out the ideas of others to reach the best solutions
- Acknowledges and celebrates the contribution of others time efficiently
Pay Range
$235,000.00 - $280,000.00
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
