The Physician Advisor Lead provides clinical leadership, mentorship, quality oversight, and operational support to HURC’s Physician Advisor team while maintaining an active production workload. Serving as a senior Physician Advisor and clinical subject matter expert, this role promotes consistent clinical decision-making, effective payer-to-provider communication, and high-quality utilization management outcomes across HURC client engagements.
The Physician Advisor Lead partners with HURC leadership, Physician Advisors, Utilization Review teams, and clients to improve medical necessity determinations, peer-to-peer (P2P) performance, denial prevention, and overall utilization management outcomes.
Key Responsibilities
- Provide clinical leadership, mentorship, and day-to-day support to HURC Physician Advisors.
- Maintain an active production workload and perform Physician Advisor duties on assigned client accounts.
- Serve as a senior clinical resource for complex, high-priority, and escalated utilization review, medical necessity, and P2P cases.
- Establish and promote consistent clinical, documentation, communication, and client-service standards.
- Conduct and oversee regular Physician Advisor quality and call audits.
- Monitor key performance indicators, including P2P completion, callback responsiveness, overturn rates, quality, timeliness, and client service.
- Identify performance trends and opportunities for coaching, education, and process improvement.
- Partner with HR and Operations on performance reporting, management, and improvement initiatives.
- Support Physician Advisor onboarding, training, and ongoing professional development.
- Develop and maintain educational resources, reference materials, and standardized best practices for P2P preparation, documentation, escalation, follow-up, and payer communication.
- Serve as a senior clinical resource for clients regarding escalated clinical and operational issues.
- Participate in client meetings, operational reviews, and clinical discussions as needed.
- Identify trends in denials, medical necessity determinations, payer behavior, and utilization management practices that affect client outcomes.
- Collaborate with HURC leadership to develop clinical recommendations, improve workflows, and expand Physician Advisor services, SME offerings, and specialized clinical programs.
- Support the ongoing development and standardization of HURC’s Physician Advisor program.
Qualifications
- Active, unrestricted U.S. physician license.
- Board certification in an appropriate specialty.
- Significant Physician Advisor experience, including the ability to maintain an active production workload.
- Strong background in utilization management, hospital medicine, healthcare revenue cycle, or a related clinical setting.
- Demonstrated expertise in P2P reviews, medical necessity determinations, inpatient admission criteria, continued stay reviews, denials, appeals, and payer processes.
- Experience managing complex clinical cases and conducting payer-to-provider negotiations.
- Strong written and verbal communication, negotiation, and collaboration skills.
- Experience mentoring, coaching, or leading physicians preferred.
- Experience with Epic or other major EHR platforms preferred.
- Ability to work effectively in a remote, client-facing environment while meeting clinical leadership, production, quality, timeliness, and client-service expectations.
- Travel as needed.