Job Description

About this Job:
Physician Advisor - MedStar Washington Hospital Center and MedStar Georgetown University Hospital
MedStar Health is seeking a Physician Advisor to join our team in a hybrid role supporting both MedStar Washington Hospital Center and MedStar Georgetown University Hospital in Washington DC. The Physician Advisor is an essential part of the team, using medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials. Their work ensures patients receive appropriate, timely care.
In this role, you'll:

• Review patient status, medical necessity, and level of care
• Lead clinical denial interventions, denial root cause determinations and upstream process improvement initiatives
• Engage in concurrent and retrospective denials management and peer to peer discussions with payers
• Drive length of stay improvements in close collaboration with case management and hospital stakeholders
• Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative level of care
• Participate in Interdisciplinary Rounds (IDR) with the Healthcare Team as indicated
• Ensure regulatory compliance of Utilization Management and Discharge planning processes

At MedStar Health, you can expect:

• A competitive salary
• Medical, dental, and vision insurance
• Paid malpractice insurance
• Paid Time Off
• Retirement plan

Education/Training:

• Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) - Board Certification required (Internal Medicine or Emergency Medicine preferred)
• Preferred: Additional certification in healthcare administration, business, or physician advisory

Experience:

• Minimum 5 years of direct clinical practice required, hospital based experience preferred
• Previous experience as physician advisor preferred
• Strong knowledge of case management, utilization review, regulatory standards, denials management, observation medicine, and length of stay
• Familiarity with MCG and InterQual clinical criteria

Licensure/Certification:

• Current medical license in the practicing state
• Board Certified
• Preferred: ACPA-C or ABQUARP certification in Physician Advisory (or willingness to obtain within 1 year of hire)

This position has a hiring range of : USD $250,000.00 - USD $350,000.00 /Yr.

Skills Required