ZipRecruiter

Log In

1

Physician Advisor Utilization Review Jobs (NOW HIRING)

CHRISTUS Health

Physician Advisor

Beaumont, TX · On-site

Elizabeth is seeking a full-time Physician Advisor to join their team in Beaumont, TX. This ... Lead the Utilization Review Committee in collaboration with the Director of CM * Conduct secondary ...

CHRISTUS Health

Physician Advisor

Texarkana, TX

Michael hospital is seeking a Physician Advisor to serve in a full-time administrative role ... Lead the Utilization Review Committee in collaboration with the Director of CM * Conduct secondary ...

previous page

Showing results 41-60

All JobsPhysician Advisor Utilization Review Jobs

Physician Advisor Utilization Review information

See salary details

$50K

$204.2K

$355.5K

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

As of Aug 18, 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.

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 does a physician advisor utilization review 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.

What are the key skills and qualifications needed to thrive as a physician advisor utilization review?

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.

How does a physician advisor 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 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.

Is physician advisor utilization review a good job?

Physician advisor utilization review is a healthcare role that involves evaluating medical necessity and optimizing resource use, often requiring clinical expertise and knowledge of insurance policies. It can offer a stable career with opportunities for advancement and work-life balance, especially in hospital or insurance settings. Job satisfaction depends on individual interests in clinical decision-making and healthcare management.
More about Physician Advisor Utilization Review jobs

What cities are hiring for Physician Advisor Utilization Review jobs?

Cities with the most Physician Advisor Utilization Review job openings:

What are the most commonly searched types of Physician Advisor Utilization Review jobs?

The most popular types of Physician Advisor Utilization Review jobs are:

What states have the most Physician Advisor Utilization Review jobs?

States with the most job openings for Physician Advisor Utilization Review jobs include:

What job categories do people searching Physician Advisor Utilization Review jobs look for?

The top searched job categories for Physician Advisor Utilization Review jobs are:

Physician Advisor Utilization Review jobs near you
Infographic showing various Physician Advisor Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $204,193 per year, or $98.2 per hour.

Utilization Review Nurse- Care Coordination Department

Vassar Brothers Medical Center

Poughkeepsie, NY • On-site, Remote

$48.49 - $73.58/hr

Full-time

Re-posted 4 days ago

Job description

Description
Position at Vassar Brothers Medical Center
Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State's largest private employer with over 104,000 employees - including members of Northwell Health Physician Partners - who are working to change health care for the better.
Summary:
The Utilization Review Nurse is responsible for conducting timely, accurate, and comprehensive clinical reviews to ensure that patients receive the appropriate level of care in accordance with regulatory, payer and organizational guidelines. The Utilization Review Nurse applies evidence-based criteria to evaluate medical necessity and collaborates with physicians and interdisciplinary team members to reduce denials and ensure compliance with CMS and payer regulations.
Responsibilities:
1. Clinical Review & Level of Care Determination
  • Performs initial, concurrent, and discharge utilization reviews to determine the appropriate patient status (inpatient, observation, outpatient).
  • Applies InterQual, MCG, or payer-specific criteria in accordance with CMS regulations and the Two-Midnight Rule.
  • Collaborates with admitting providers to obtain timely admission orders and correct patient status when discrepancies arise.
  • Ensures MOON, IMN, HINN (etc.) notices are issued and documented per policy.
2. Payer Communication & Authorization Management
  • Conducts timely payer notifications with complete reviews and all supporting clinical documentation via fax or payer portal.
  • Provides clinical updates and facilitates peer-to-peer reviews as required.
  • Maintains documentation of all payer interactions in Cerner.
  • Securely maintains all relevant login credentials for all payer portals.
  • Demonstrates proficiency in navigating payer portals to efficiently retrieve and submit required data.
3. Collaboration with Clinical Team
  • Discusses cases with the attending MD when a clinical review does not meet inpatient medical necessity at the first-level review to obtain additional clinical information and documentation to support inpatient level of care; if the case still does not meet criteria, sends it to the Physician Advisor for a second-level review.
  • Forwards cases requiring secondary physician review to the appropriate resource (e.g., Physician Advisor).
  • Resolves discrepancies at the time of review or escalates unresolved issues to the Physician Advisor and departmental leadership.
  • Coordinates with the care team to change patient status as needed.
  • Notifies the care team when a patient does not meet medical necessity per InterQual, MCG guidelines, or the Two-Midnight Rule and escalates appropriately.
4. Compliance & Performance Standards
  • Adheres to all federal, state, payer, and hospital compliance requirements related to utilization management.
  • Maintains confidentiality of patient information in accordance with HIPAA.
  • Meets productivity standards, including review volume, timeliness, and documentation quality.
5. Hybrid Work Standards and Accountability
  • Adheres to the standards outlined in the Nuvance Health Remote Work Program Policy when utilizing a hybrid work arrangement.

Maintains and models organization values.
Demonstrates regular, reliable and predictable attendance.
Performs other duties as required.
Education Skills Experience:
Associate's degree in nursing
3 years experience in acute care or subacute care Nursing
3 years experience as Utilization Management Nurse in an acute care or subacute care setting preferred.
PREFERRED: Bachelor's degree or master's degree in nursing Current NYS RN License.
CCM/ACM Preferred
NYS PRI certification preferred; required within 60 days of hire. MCG Certification Preferred
Working Conditions
Derived Working Conditions
Essential:
* Significant manual skills / motor coord & finger dexterity
* Significant occupational risk
* Very Heavy effort. May exert up to 50 lbs. force
* Significant exposure to dirt, odor, noise, human waste, etc.
Company: Vassar Brothers Medical Center
Org Unit: 1190
Department: Care Coordination
Exempt: No
Hourly Rate: $48.49-$73.58

Apply