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$50K

$204.2K

$355.5K

How much do physician advisor utilization review jobs pay per year?

As of Jul 29, 2026, the average yearly pay for physician advisor utilization review in the United States is $204,193.00, according to ZipRecruiter salary data. Most workers in this role earn between $164,500.00 and $233,000.00 per year, depending on experience, location, and employer.

How does a Physician Advisor in Utilization Review typically collaborate with clinical and administrative teams to ensure efficient patient care and resource management?

Physician Advisors in Utilization Review work closely with both clinical staff, such as physicians and nurses, and administrative teams, including case managers and compliance officers. They facilitate effective communication regarding patient care decisions, ensuring that treatment plans align with evidence-based guidelines and payer requirements. This role often involves reviewing medical records, providing guidance on appropriate admission status, and participating in interdisciplinary meetings to resolve complex cases. By acting as a bridge between clinical staff and hospital administration, Physician Advisors help optimize resource utilization while maintaining high standards of patient care.

What is a Physician Advisor Utilization Review?

A Physician Advisor Utilization Review is a medical professional who helps healthcare organizations ensure that patient care meets clinical, regulatory, and reimbursement guidelines. They review patient records to determine the necessity and appropriateness of hospital admissions and ongoing care. Physician Advisors also provide guidance on best practices, work with case management teams, and assist with appeals and denials from insurance companies. Their goal is to support quality care while optimizing resource use and compliance.

What are the key skills and qualifications needed to thrive as a Physician Advisor Utilization Review, and why are they important?

To thrive as a Physician Advisor Utilization Review, you typically need a medical degree (MD or DO), board certification, and a comprehensive understanding of clinical best practices and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of CMS guidelines are essential, and certification such as CHCQM (Certified in Healthcare Quality Management) can be beneficial. Strong analytical skills, clear communication, and the ability to collaborate with clinical and administrative teams help physicians excel in this role. These skills are crucial for ensuring appropriate patient care, regulatory compliance, and effective resource utilization within healthcare organizations.

What is the difference between Physician Advisor Utilization Review vs Physician Reviewer?

AspectPhysician Advisor Utilization ReviewPhysician Reviewer
CredentialsMedical degree, board certification, often with utilization review or healthcare management experienceMedical degree, board certification, typically with clinical experience
Work EnvironmentHospitals, insurance companies, healthcare organizations focusing on utilization managementHospitals, clinics, insurance companies reviewing patient cases
Primary FocusOverseeing utilization review processes, ensuring appropriate care, and complianceConducting case reviews, providing clinical opinions on individual cases

Physician Advisor Utilization Review professionals focus on managing healthcare utilization and ensuring compliance, often working in administrative roles. In contrast, Physician Reviewers primarily evaluate individual cases from a clinical perspective. Both roles require medical credentials, but their responsibilities and work settings differ.

What Does a Utilization Review Physician Advisor Do?

Utilization review is the assessment of the appropriateness of medical treatment before insurers approve its use in practice. As a utilization review physician advisor, you review clinical information and insurance coverage for patients to determine if they have eligibility to receive particular forms of treatment and if the treatment is medically necessary. Each case is usually analyzed by a utilization nurse first; when there are questions or issues that arise, they pass the file to you for examination. You evaluate the claims based on a set of qualifications and guidelines detailed by the review board with the primary goal of keeping costs down.

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Physician Advisor Utilization Review jobs near you
Infographic showing various Physician Advisor Utilization Review job openings in the United States as of July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $204,193 per year, or $98.2 per hour.

Physician Advisor Utilization Review(MD/DO)

Inova

Fairfax, VA • Hybrid

Part-time

Medical, Dental, Vision, PTO

Re-posted 5 days ago

Inova Health System rating

7.5

Company rating: 7.5 out of 10

Based on 251 frontline employees who took The Breakroom Quiz

230th of 890 rated healthcare providers

Job description

Inova Fairfax Medical Campus is looking for a dedicated physician advisor to join the Utilization Review Advisor team. This role will be a part-time position.


The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Inova hospital facilities. The Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients. The Advisor interfaces directly with UR nurses and medical staff, providing concurrent communication and education regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.


Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. 


Featured Benefits:
      Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
       Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
         Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
         Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
          Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities.

MD Physician Advisor Additional Requirements:

  • Completion of an accredited residency training program
  • Active and unrestricted state Virginia medical license
  • Board certification in specialty required at time of hire
  • Possess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions 
  • Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments 
  • Familiarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient specific variables as may be necessary or justifiable   
  • Familiarity with (Hospital) organization and case management operations    
  • Excellent customer service and interpersonal skills
  • Able to effectively present information, both formal and informal
  • Superb written and verbal communications skills
  • Ability to set and manage priorities
  • Demonstrate flexibility, teamwork, and a collaborative leadership style
  • Strong technical/computer

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