Physician Advisor

This advisory role drives clinical oversight in healthcare appeals, where experts provide medical guidance to review teams for utilization cases and denials, ensuring patients receive validated care decisions that uphold hospital standards and potentially improve claims outcomes. Advisors draw on medical knowledge to assess necessity under Interqual Criteria, acting as physician experts in Pennsylvania Medical Assistance reviews and appeals processes.

Temple University Hospital operates as a nationally respected teaching hospital on Temple University's Health Sciences Center campus, providing comprehensive care ranging from basic to complex treatments to patients from around the country. The hospital includes dynamic environments for teaching, research, and high-quality care, serving as the chief clinical training site for the Lewis Katz School of Medicine.

Led activities involve offering clinical expertise to Clinical Analysis and appeals team, acting as the physician advisor for medical necessity appeals, and serving as a resource for regulatory and revenue cycle denial and appeals processes. Advisors use electronic health records, Interqual Criteria sets, and hospital reimbursement systems. They interact with review teams, sponsors, and regulatory bodies, adhering to utilization management protocols that require handling complex cases without direct patient care, and must be prepared for second and third level appeals including expert witness duties.

This full-time day shift position includes a competitive salary, full medical, dental, and vision coverage, paid time off with 11 holidays, tuition remission, and a retirement plan. The role requires a Doctorate Degree Medicine or Osteopathic Medicine, relevant general experience including preferred administrative leadership, and licenses including PA Medical Physician License or PA Osteopathic Physician License.