PHYSICIAN ADVISOR

We are seeking a detail-oriented Physician Advisor to join our inpatient team full-time. This role serves as a key clinical and operational leader, supporting effective utilization of healthcare services and ensuring compliance with payer and regulatory requirements.

About the role

The Physician Advisor provides expertise in medical necessity, documentation, care progression, and denial management, working closely with Care Management, Utilization Review, Revenue Cycle, and hospital leadership. This position includes rotating weekend call coverage. Reporting to the Chief Medical Officer, the Physician Advisor partners with medical staff leadership, providers, and resource management teams to optimize utilization practices and support organizational goals.

Responsibilities

• Make recommendations on level of care including initial level of care, secondary review, and as requested by case management.
• Recommend documentation improvements to ensure the medical record accurately reflects the patient’s clinical status, supports the level of care provided, and meets regulatory and payer requirements.
• Collaborate with providers to identify opportunities for enhanced documentation that clarifies the rationale for services rendered, severity of illness, and care progression, reducing the risk of denials and facilitating appropriate reimbursement.
• Review daily level of care recommendations on cases placed in Observation.
• Participate in and lead denial management processes, including performing peer-to-peer appeals and drafting appeal letters for third-party denials where appropriate.
• Apply the 2-midnight rule to Medicare reviews and maintain compliance with Medicare rules as they apply to level of care recommendations.
• Stay current on changes in payer rules, including CMS rules, as they pertain to utilization review.
• Recommend and request additional or more complete medical record documentation from providers to support placement status or medical necessity.
• Understand and use InterQual, MCG, and/or other appropriate criteria.
• Apply medical expertise to assist with appropriate billing for services.
• Provide feedback on payer denial patterns where appropriate.
• Aid in supporting Length of Stay (LOS) strategies (avoidable days) and quality goals.
• Facilitate, mentor, and educate other physicians regarding documentation and payer requirements.
• Facilitate, mentor, and educate case management on the utilization review process where appropriate.
• Perform other duties as assigned to support the unit, department, entity, and health system organization.

Requirements

• MD or DO degree.
• Possess and maintain an unrestricted medical license in the State of Illinois.
• Minimum 5 years of clinical experience in a hospital setting.
• Possess or develop a solid foundation in the areas of utilization management and hospital operations.

Preferred Qualifications

• Palliative Care Fellowship.
• American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Health Care Quality and Management (HCQM) certification.
• American College of Physician Advisors certification (ACPA-C).

Work Environment

Location: Riverside Medical Group, 350 N. Wall St., Kankakee, IL.

Exposure:

• Chemicals: Refer to MSDS Sheets.
• Video Display Terminals: Average.
• Blood and Body Fluids: None.
• TB or Airborne Pathogens: None other than normal hospital environment exposure.

Sensory Requirements:

• Speech: Required for presentations, training, telephone communication, meetings, and interactions with providers and staff.
• Vision: Needed to read memos, literature, type correspondence from handwritten material, and coordinate calendars.
• Smell: Helpful to note presence of electrical/fire safety.
• Hearing: Needed for telephone communication, meetings, alarms, and listening to employees/staff.
• Touch: Needed for writing, computer entry, and filing.

Activity/Lifting Requirements:

• Percentage of time during the normal workday:
  • Sit: 70%
  • Stand: 10%
  • Walk: 15%
  • Lift: 5%
  • Squat: 5%
  • Bend: 5%
  • Twist, Crawl, Kneel, Climb, Reach above shoulders: 0-1%
• Weight lifted each normal workday:
  • Up to 10 lbs: Occasionally
  • Up to 20 lbs: Occasionally
  • Up to 35 lbs: Occasionally
  • Up to 50 lbs and above: Not Required
• Maximum consecutive time (minutes) during the normal workday:
  • Sit: 120
  • Stand: 30
  • Walk: 5
  • Kneel: 2
  • Squat: 5
  • Bend: 5
  • Reach above shoulders: 2
• Repetitive Use of Hands:
  • Simple grasp up to 1 lb: Frequent
  • Pushing & pulling (normal weight: 5 lbs): Frequent
  • Fine manipulation: Moving charts, written documentation.

Environmental Factors:

• Inside hours: 8
• Outside hours: 0
• Temperature: Normal Range
• Lighting: Average
• Noise levels: Average
• Humidity: Normal Range
• Atmosphere: Normal Range
• Special Hazards: None
• Protective Clothing Required: None

Pay

USD $95.38 - USD $141.06 per hour.