Care Management & Utilization Management Physician Advisor

Care Management & Utilization Management Physician Advisor The Care Management & Utilization Management Physician Advisor is a physician leader who works across clinical and operational domains to improve the quality, efficiency, coordination, financial integrity, and value of care. The Physician Advisor serves as a trusted liaison among the medical staff, Patient Care Services, Care Management, Utilization Management, Clinical Documentation Integrity (CDI), Coding, Quality and Patient Safety, Transitional Care, Access, Patient Relations, Patient Experience, Finance, Revenue Cycle, and hospital administration. The role extends beyond traditional utilization review and supports hospital-wide clinical operations, accurate clinical documentation and coding, risk adjustment, care progression, physician engagement, performance improvement, high-value care, and complex-case problem solving. The Physician Advisor helps operationalize the organization's Avoid-Adjust-Improve quality strategy. AVOID focuses on preventing inaccurate representation of the patient's clinical condition, including inappropriate principal diagnosis selection, clinical validation concerns, and incorrect cohort assignment. ADJUST focuses on ensuring that clinically supported patient complexity and severity are accurately documented and coded. IMPROVE focuses on measurable improvement in clinical outcomes, safety, reliability, care delivery, and patient experience. The Physician Advisor is expected to integrate all three domains so that organizational performance reflects both the care delivered and the true complexity of the patients served. The Physician Advisor applies clinical judgment, regulatory knowledge, data, and physician leadership to promote documentation and coding that are clinically valid, compliant, and consistent with the patient's actual condition while simultaneously improving care delivery and outcomes.