Director, Medical Physician Advisor at Jobgether – United States

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Director, Medical Physician Advisor in the United States.

This role provides expert clinical leadership and advisory support across Utilization Management (UM) and Care Management (CM) functions, bridging the gap between medical staff, payors, and operational teams. The Director serves as a key resource for improving clinical documentation, patient safety, and quality outcomes while ensuring cost-effective care delivery. This position drives collaboration among physicians, UM/CM teams, and external stakeholders, helping to navigate complex clinical and regulatory questions. The role involves reviewing utilization patterns, managing authorizations and denials, and supporting peer-to-peer discussions to optimize patient care and operational efficiency. Success is measured by improved clinical outcomes, enhanced provider engagement, and strengthened organizational processes. This is a full-time role with a combination of remote and on-site responsibilities.

• Provide clinical support and validation for Utilization Management and Care Management processes.
• Serve as a trusted advisor to medical staff, educating and guiding UM/CM teams on best practices and clinical guidelines.
• Act as a liaison between facilities, payors, physicians, and organizational programs to promote high-quality, cost-effective care.
• Guide UM staff on authorizations, concurrent reviews, denials, and medical necessity criteria.
• Conduct secondary inpatient review escalations and evaluate utilization trends for process improvements.
• Support claims management, appeals, and peer-to-peer discussions with payors.
• Collaborate with Quality, Patient Safety, and Clinical Documentation teams to enhance clinical outcomes and compliance.

Requirements:

• Medical Doctor (MD) degree from an accredited medical school; Master’s in Business or Healthcare Administration preferred.
• 5+ years of hospital medicine experience in acute care settings; 2+ years as a Physician Advisor preferred.
• Proven experience in Utilization Management, Care Management, or payor operations.
• Strong analytical, problem-solving, and organizational skills, with attention to detail.
• Excellent oral and written communication skills, able to convey complex clinical concepts to diverse stakeholders.
• Ability to navigate matrix-management environments and balance ethical, legal, and operational considerations.
• Demonstrated ability to build and sustain professional relationships in medical and corporate environments.
• Knowledge of change management principles and healthcare quality management certifications preferred.

Benefits:

• Comprehensive health coverage including medical, dental, vision, life, and disability insurance from day one.
• Paid time off and four weeks of fully paid parental leave.
• Retirement plan with employer contributions (403-B).
• Career development programs and professional growth opportunities.
• Whole person well-being and mental health resources, including support for family and pets.
• Full-time schedule with flexibility and supportive work environment.