Lead Physician Advisor - Centralized Utilization Review - FT Days - MHS

Location:

Miramar, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary:

The Physician Advisor Lead serves as the clinical and operational leader for the physician advisor team, guiding the strategic execution of utilization review, medical necessity compliance, and care optimization initiatives across the hospital system. This position combines direct clinical support with team leadership responsibilities, ensuring alignment with CMS regulations, efficient throughput, and denial prevention. The Lead partners closely with Case Management (CM), Utilization Review (UR), Coding, and Executive Leadership to monitor and improve system performance in key utilization metrics.

Responsibilities:

Clinical Operations: Performs secondary reviews for level of care determinations, including inpatient vs. observation and continued stay. Conducts peer to peer conversations with payer medical directors to address concurrent denials and avoid revenue loss. Serves as the clinical bridge between hospitalist providers and administrative teams for utilization efficiency.Process Improvement and Strategic Support: Identifies patterns in denials, or documentation gaps and lead corrective action planning. Collaborates with leadership in UR, CM, and CDI to ensure workflows are aligned for efficient discharge planning and accurate status assignment. Participates in denial prevention workgroups, length of stay (LOS) reduction committees, and multidisciplinary rounds.Education and Provider Engagement: Leads provider education on medical necessity, documentation, and regulatory compliance. Develops and disseminates guidance tools, clinical pathways, and feedback to hospitalist teams and specialists.Leadership and Oversight: Provides direct leadership to the physician advisor team, ensuring consistency in medical necessity reviews, payer interactions, and documentation education. Ensures consistency with established workflows and assigns, monitors, and oversees physician advisor case reviews as applicable to ensure timely completion and high-quality determinations. Serves as the escalation point for complex reviews, payer disputes, and provider engagement concerns. Facilitates onboarding, training, and performance feedback for physician advisors.

Competencies:

Education and Certification Requirements:

Medical Doctor (Required)Medical Doctor License (ME LICENSE) - State of Florida (FL), Osteopathic Physician License (OS LICENSE) - State of Florida (FL)

Additional Job Information:

Complexity of Work: This role requires exceptional clinical judgment, a deep understanding of utilization management and payer policies, and the ability to lead both through influence and formal leadership. The Physician Advisor Lead must be able to manage sensitive provider relationships, ensure adherence to compliance standards, and drive system wide process improvements in a dynamic hospital environment. Required Work Experience: Minimum of three (3) years’ clinical practice. At least, two (2) years’ experience as a physician advisor or in a similar utilization management leadership role preferred. Other Information: Other Certification Info: Board certification in a clinical specialty required. Certification or formal training in Utilization Review or Physician Advisor practice (e.g., CHCQM, ABQAURP) strongly preferred.

Working Conditions and Physical Requirements:

• Bending and Stooping = 60%
•    Climbing = 40%
•    Keyboard Entry = 100%
•    Kneeling = 40%
•    Lifting/Carrying Patients 35 Pounds or Greater = 0%
•    Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
•    Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
•    Lifting or Carrying > 75 lbs Non-Patient = 0%
•    Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
•    Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
•    Pushing or Pulling > 75 lbs Non-Patient = 0%
•    Reaching = 60%
•    Repetitive Movement Foot/Leg = 40%
•    Repetitive Movement Hand/Arm = 100%
•    Running = 0%
•    Sitting = 100%
•    Squatting = 80%
•    Standing = 80%
•    Walking = 80%
•    Audible Speech = 100%
•    Hearing Acuity = 100%
•    Smelling Acuity = 0%
•    Taste Discrimination = 0%
•    Depth Perception = 60%
•    Distinguish Color = 60%
•    Seeing - Far = 60%
•    Seeing - Near = 60%
•    Bio hazardous Waste = 40%
•    Biological Hazards - Respiratory = 0%
•    Biological Hazards - Skin or Ingestion = 0%
•    Blood and/or Bodily Fluids = 40%
•    Communicable Diseases and/or Pathogens = 0%
•    Asbestos = 0%
•    Cytotoxic Chemicals = 0%
•    Dust = 0%
•    Gas/Vapors/Fumes = 0%
•    Hazardous Chemicals = 0%
•    Hazardous Medication = 0%
•    Latex = 0%
•    Computer Monitor = 80%
•    Domestic Animals = 40%
•    Extreme Heat/Cold = 40%
•    Fire Risk = 0%
•    Hazardous Noise = 0%
•    Heating Devices = 0%
•    Hypoxia = 0%
•    Laser/High Intensity Lights = 0%
•    Magnetic Fields = 0%
•    Moving Mechanical Parts = 0%
•    Needles/Sharp Objects = 0%
•    Potential Electric Shock = 0%
•    Potential for Physical Assault = 40%
•    Radiation = 0%
•    Sudden Decompression During Flights = 0%
•    Unprotected Heights = 0%
•    Wet or Slippery Surfaces = 0%

Shift:

Primarily for office workers - not eligible for shift differential

Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer, pre-placement assessment, including drug testing.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net