The Physician Advisor (PA) plays a critical role in ensuring high-quality, efficient, and compliant patient care. Reporting through the CFO and working closely with case management and clinical leadership, the PA reviews clinical cases to support appropriate utilization, discharge planning, documentation, and regulatory compliance. The PA serves as a resource and liaison among attending physicians, hospital departments, third-party payers, and regulatory bodies to optimize care delivery, promote accurate clinical documentation, and support the organization's mission.
Key Responsibilities
Care Management Support
Conduct clinical reviews for the appropriate level of care, resource utilization, and length of stay.
Assist in denial management and collaborate on issuing Medicare notices of non-coverage.
Act as liaison with payers for peer-to-peer reviews and authorization processes.
Participate in interdisciplinary rounds and review long-stay cases to support discharge planning and continuity of care.
Lead Utilization Management Committees to drive efficiency, revenue integrity, and case management goals.
Physician Support and Education
Provide feedback and education to physicians on the level of care, documentation, and payer requirements.
Support peer-to-peer communications and attend relevant medical staff meetings.
Serve on committees, task forces, and hospital projects requiring physician insight.
Clinical Documentation Improvement (CDI)
Collaborate with CDI professionals, HIM, and medical staff to improve documentation accuracy, DRG assignment, and coding integrity.
Educate providers on documentation standards, ICD coding, and clinical terminology to reflect severity, acuity, and risk of mortality.
Drive initiatives to improve documentation practices at both the individual and departmental levels.
Process & Quality Improvement
Identify and address issues impacting quality, safety, satisfaction, and efficiency.
Promote a team-based care model and effective communication across departments.
Participate in performance improvement initiatives, protocol development, and metrics monitoring.
Serve on hospital committees, including ethics and quality improvement teams.
Leadership Competencies
Drives Results – Delivers outcomes in complex situations.
Customer Focus – Builds strong relationships and delivers patient-centric solutions.
Instills Trust – Models integrity, honesty, and authenticity.
Collaborates – Promotes teamwork and shared goals.
Communicates Effectively – Adapts messaging for diverse audiences.
Organizational Responsibilities
Attend departmental meetings and complete all mandatory training and competencies.
Maintain all required licenses, certifications, and health screenings.
Adhere to infection control, safety, and compliance protocols.
Available to work alternate shifts or overtime when necessary.
Beacon Way Commitment
Leverage innovation
Cultivate talent
Embrace continuous improvement
Build accountability
Use data for informed decisions
Communicate openly and consistently
Qualifications
Education & Licensing
MD or DO from an accredited medical school.
Active license to practice medicine in Indiana.
Member of the organized medical staff.
Board certification in a clinical specialty; certification in Utilization Review (e.g., ABQAURP) preferred.
Experience
Experience in case management, utilization review, or medical staff affairs is required.
Skills
Strong leadership and decision-making skills.
Excellent communication and interpersonal abilities.
Proficient in interpreting clinical criteria (InterQual, Milliman).
Familiar with regulatory guidelines and quality standards.
Working Conditions
Primarily office-based with occasional participation in clinical settings.
Requires physical stamina to meet position demands.