Top 30 Utilization review physician Jobs in Georgia

Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE
St. Mary's Health care System —Athens, GA
- Full-time
- Medicine
- Hospital
- Customer service
Remote Inpatient Medicare Medical Director
Centene Medicare —Georgia
- $236,500 - $449,300 a year
- Weekends as needed
- Remote
- Medicine
- Fair chance
- Senior level
- Paid holidays
- Health insurance
7d
Remote Behavioral Medical Director, Eastern Region
Centene —Georgia
- $236,500 - $449,300 a year
- Weekends as needed
- Remote
- Medicine
- Psychiatry
- Neurology
- Paid holidays
- Health insurance
Board-Certified Orthopedic Surgeon
Dane Street, LLC —Savannah, GA
- Contract
- Surgery
- Analysis skills
- Senior level
Quick Apply
Board-Certified Psychiatrist
Dane Street, LLC —Savannah, GA
- Contract
- Psychiatry
- Analysis skills
- Senior level
Quick Apply
Assistant Chief Medical Officer
Memorial Health University Medical Center —Savannah, GA
- Full-time
- 5 years
- Senior level
- Leadership
- Employee stock purchase plan
- Disability insurance
Quick Apply
Senior Medical Director
Oak Street Health —Riverdale, GA
- $184,112 - $396,550 a year
- Full-time
- Medicine
- Outpatient experience
- 3 years
- Health insurance
- Dental insurance
Physician Lead
Centerwell —Savannah, GA
- $292,000 - $341,500 a year
- Full-time
- Medicine
- Clinic
- Geriatrics
- Paid parental leave
- Paid holidays
Division Physician Executive
Core Clinical Partners —Atlanta, GA
- Remote
- Medicine
- 7 years
- Hospital
Quick Apply
11d
Vice President, Chief Medical Officer, Georgia Area
Atrium Health —Rome, GA
- $200.55 - $320.90 a day
- Full-time
- Medicine
- Hospital
- 5 years
- Paid parental leave
- Disability insurance
2d
Hospitalist Medical Director
Sound Physicians —Macon, GA
- Full-time
- Internal Medicine
- Critical & Intensive Care
- US work authorization
Physician-Neurology
US Veterans Health Administration —Augusta, GA
- $250,000 - $315,000 a year
- Online Application
- Background check
- Medicine
- Surgery
- Paid holidays
- Loan repayment program
Physician Services
Dymentum Health —Jesup, GA
- Online Application
- Nursing
- PALS Certification
- BLS Certification
Quick Apply
Hospice Medical Director
Gentiva —Savannah, GA
- Full-time
- CPR Certification
- Medicine
- BC/BE
Quick Apply
Medical Director of Outpatient Psychiatry
5000 Wellstar Medical Group, LLC —Marietta, GA
- Online Application
- Medicine
- Psychiatry
- Primary Care
Market Physician Executive (MPE) - Atlanta, GA
Monogram Health Professional Services —Atlanta, GA
- On call
- Medicine
- Critical & Intensive Care
- Travel
- Health insurance
- Dental insurance
Quick Apply
Hospice Physicians
Gentiva —Brunswick, GA
- Per diem
- CPR Certification
- Medicine
- BC/BE
Quick Apply
Travel Team Medical Director
Core Clinical Partners —Atlanta, GA
- Medicine
- Hospital
- 5 years
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Brunswick, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Hospice Physician
Gentiva —Vidalia, GA
- Per diem
- CPR Certification
- Medicine
- BC/BE
Quick Apply

I want to receive the latest job alert for utilization review physician in georgia

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review physician jobs near georgia

Physician jobs in Brunswick, GA

Medical Director jobs in Atlanta, GA

Medical Director jobs in Marietta, GA

Physician jobs in Atlanta, GA

Medical Director jobs in Savannah, GA

Medical Director jobs in Georgia

Medical Director jobs in Macon, GA

Physician jobs in Savannah, GA

Psychiatrist jobs in Savannah, GA

Clinical Documentation Improvement Specialist jobs in San Francisco, CA

Clinical Documentation Improvement Specialist jobs in Cedar Rapids, IA

Home Improvement Sales jobs in San Diego, CA

Healthcare Quality Improvement Remote jobs in California

Clinical Documentation Improvement Specialist jobs in Remote

Clinical Documentation Improvement Specialist jobs in Boston, MA

Clinical Research Coordinator jobs in Winston Salem, NC

Pediatric Physician Assistant jobs in California

Physician Assistant jobs in Middletown, NY

Remote Physician jobs in New York, NY

Physician Liaison jobs in Houston, TX

Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE

St. Mary's Health care System -
Athens, GA

Apply Now

Job Details

Full-time

Qualifications

Direct patient care
Inpatient experience
Customer service
Team leadership
BC/BE
Clinical information systems
Conflict management
Leading team collaboration initiatives
Medical License
Computer skills
Clinical team leadership
Hospital experience
Team building

Full Job Description

Employment Type:
Full time

Shift:
Description:
THIS IS A 1099 POSITION

The Physician Advisor serves as a physician leader responsible for improving clinical documentation accuracy, case mix index (CMI), medical necessity compliance, utilization management, and hospital throughput.

The Physician Advisor works collaboratively with physicians, case management, clinical documentation integrity (CDI), quality, and revenue cycle teams to ensure appropriate patient status determinations, documentation accuracy, regulatory compliance, and optimal use of hospital resources.

This role provides in person, peer-to-peer physician engagement and education to support compliant documentation, reduce denials, decrease avoidable length of stay, and ensure appropriate utilization of hospital services.

Key Responsibilities and Essential Functions
Clinical Documentation& Case Mix

Partner with CDI specialists to improve clinical documentation accuracy and completeness
Provide physician-to-physician education on documentation requirements related to:
Severity of illness
Risk of mortality
CC/MCC capture
DRG assignment
Assist with case mix index (CMI) improvement initiatives
Review complex cases for documentation opportunities that accurately reflect patient acuity

Utilization Management& Length of Stay Optimization

Provide physician guidance for medical necessity determinations
Review cases for appropriate inpatient vs observation status
Support case management staff with complex utilization reviews
Conduct peer-to-peer reviews with payers
Collaborate with care management teams to identify and address barriers to timely discharge
Work with clinical teams to reduce avoidable length of stay and excess days
Participate in daily multidisciplinary rounds and discussions to address throughput challenges and delayed discharges
Work with our Internal Medicine Residents to teach them what a Physician Advisor does and how to align and balance patient care with the KPI’s the Physician Advisor works on to improve.

Opportunity Days Reduction

Review cases with extended length of stay to identify clinical, operational, or documentation barriers contributing to opportunity days
Partner with case management, nursing leadership, and service line leaders to address drivers of avoidable hospital days
Provide physician leadership in resolving delays related to:
Clinical decision-making
Documentation gaps
Discharge readiness
Specialist consultation delays
Support hospital initiatives aimed at improving patient flow and capacity management

Denials Prevention& Appeals

Review payer denials related to:
Medical necessity
Level of care
DRG downgrades
Write and support clinical appeal letters
Participate in denials management strategy
Identify systemic issues contributing to denials and implement improvement strategies

Physician Engagement& Education

Provide education to medical staff on documentation, utilization management, and efficient care delivery
Present findings at:
Medical staff meetings
Service line meetings
Quality committees
Serve as a physician champion for documentation improvement, medical necessity compliance, and hospital throughput

Quality& Compliance

Ensure hospital practices align with:
CMS Conditions of Participation
Medicare documentation rules
Two-midnight rule
Utilization review regulations
Partner with Quality and Compliance departments to ensure regulatory alignment

Data Review& Performance Improvement

Monitor, analyze, and actively strive to improve key hospital performance metrics including, but not limited to:
Case Mix Index (CMI)
Length of Stay Index (Observed vs Expected LOS and %GMLOS)
Opportunity Days
Observation rates
Medical necessity denial rates
CC/MCC capture rate
Identify opportunities for clinical, operational, and documentation improvement

Qualifications:
Required

MD or DO degree from an accredited institution
Board Certified in a recognized medical specialty
Active unrestricted medical license to practice medicine in the state of Georgia.
Minimum of 5 years clinical practice experience
Experience working in hospital-based care
Demonstrated leadership, people management, and team building skills
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
Ability to develop and implement strategic clinical plans
Excellent oral and written communication skills
Ability to interact effectively with key internal and external constituents using collaboration and customer service skills that promote excellence in the patient experience.
Customer service orientation
Demonstrated confidence, initiative, and integrity in work practices
Goal-directed and well organized
High level of dependability and accuracy
Ability to work independently
Strong negotiation and persuasion skills
Adept at conflict management
Ability to function within a stressful environment

Strong computer skills and working knowledge of EMR’s

A broad knowledge base of health care delivery and case management within a managed care environment
Comprehensive knowledge of Utilization Review, levels of care, and observation status

Preferred

Prior experience as a Physician Advisor, Medical Director, or Utilization Review physician
Experience with:
Clinical Documentation Integrity (CDI)
Utilization Management
Revenue cycle operations
Denials management
Length of stay improvement initiatives
Knowledge of:
MS-DRG reimbursement
Case Mix Index
CMS inpatient admission criteria
Certification such as:
CHCQM-PHYADV (Certified Physician Advisor)
Additional advanced degree (MBA, MPH, MMM, etc)
Awareness of healthcare reimbursement systems (HMO, PPO, PPS,CMS)

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Apply Now

Refine Your Search

utilization review physician jobs in georgia

Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE

Remote Inpatient Medicare Medical Director

Remote Behavioral Medical Director, Eastern Region

Board-Certified Orthopedic Surgeon

Board-Certified Psychiatrist

Assistant Chief Medical Officer

Senior Medical Director

Physician Lead

Division Physician Executive

Vice President, Chief Medical Officer, Georgia Area

Hospitalist Medical Director

Physician-Neurology

Physician Services

Hospice Medical Director

Medical Director of Outpatient Psychiatry

Market Physician Executive (MPE) - Atlanta, GA

Hospice Physicians

Travel Team Medical Director

Market Physician Executive (MPE)

Hospice Physician

I want to receive the latest job alert for utilization review physician in georgia

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected