Medical Director, Physician Advisor & Utilization Management

Responsibilities: Provide physician leadership for care progression, utilization management, and clinical documentation initiatives across the organization. Collaborate with physicians, case management, nursing, and multidisciplinary care teams to optimize patient flow, improve care progression, and reduce unnecessary length of stay (LOS). Perform secondary utilization reviews, admission status determinations, continued stay reviews, and Two-Midnight Rule evaluations to ensure appropriate patient status and medical necessity. Serve as the physician resource for complex medical necessity determinations, payer requirements, CMS regulations, and accreditation standards. Review high-risk utilization management work queues, HINN cases, CC44 determinations, and other complex cases requiring physician-level review. Partner with Clinical Documentation Integrity (CDI) specialists to improve physician documentation, coding accuracy, and clinical specificity that supports quality outcomes and appropriate reimbursement. Conduct retrospective and concurrent chart reviews to identify documentation opportunities, utilization trends, and areas for clinical and operational improvement. Support denials prevention, peer-to-peer reviews, and appeals by providing physician-to-physician consultation and clinical expertise. Compensation

Minimum Hourly Rate: $115.9442

Maximum Hourly Rate: $193.6265 Shift & Schedule Onsite Days shift

Requirements: Medical Doctor Active member of a Medical Staff with at least 7 years' experience with 5 years in a leadership capacity Expertise in utilization management, state/federal regulations, private payer contracts Completion of City of Hope required onboarding and compliance training MD or DO license in California Master's in Business Administration (preferred) Hospitalist or oncology experience (preferred) Dedication to quality, safety, efficiency, satisfaction, and cost reduction Familiarity with inpatient and outpatient payer requirements Propensity for teaching others