Penn Medicine Doylestown Health

Title: Physician Advisor Relief - Case Management - Part-Time - Days

Location: Doylestown, PA

Summary

The Physician Advisor provides consulting and advisory services to the case management department and medical staff, focusing on medical necessity, levels of care, denial management, compliance with payer regulations, and documentation. Responsibilities include acute inpatient/observation review, appeals through peer-to-peer and written communication with payers, and collaboration with hospital leadership to improve outcomes.

Added on: 07/29/2025

Full Job Description

Job Description

PURPOS E OF JOB : The Physician Advisor is a physician serving the hospital through consulting and advising the case management department and the medical staff. They shall have expertise on matters regarding medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, and documentation requirements. ESSENTIAL FUNCTIONS : Provides acute inpatient/observation review services for the case management department. Provides appeal services to the case management department through Peer to Peer and written appeals with payers.

Job Qualifications

QUALIFICATIONS :

Education: Holds and maintains an unrestricted medical license in the state if PA. Experience: At least 3 years of practice as a physician in an acute care hospital. Experience in Utilization review and denial management preferred. Other Skills: Strong computer skills and working knowledge of hospital HER. Member of the American College of Physician Advisors (ACPA) preferred. Board certification by the American Board of Quality Assurance and Utilizations Review Physicians Inc. (ABQURP) preferred. Ability to build rapport with the medical staff and hospital leadership for collaboration and outcome improvement.