Do you want to make a difference as a Physician Advisor?

More and more Physicians are interested in becoming Physician Advisors.

The landscape of healthcare is ever-changing.

A role as a Physician advisor allows you to make a difference in the managed care, insurance, or pharmaceutical industry leveraging your medical knowledge and clinical expertise.

Physicians have been serving in utilization review and utilize management committee meetings since 1960 but the role became more clearly defined around 2005.

From the nonclinical career perspective, it helps to know what industry and what setting you prefer to share your expertise in.

For example, I want to serve as an onsite Physician advisor in the Hospital System

I want to be an onsite Physician advisor in a major Health plan.

I want to be a fully remote Physician advisor for a large insurance company.

The role varies and covers multiple areas of healthcare disciplines and may include leadership opportunities.

As a Physician advisor, you perform medical necessity reviews in your designated setting.

As regulatory oversight has increased over the years there has been an ongoing need for documentation improvement, cost containment, and oversight of audits and denials.

Growing health care costs have led to the need for the creation of integrated systems to ensure delivery of appropriate patient-centered care based on evidence-based medicine and thus the need for Physician advisors on both sides of health care

In the hospital setting a Physician, an advisor is a vital part of the care management team reviewing patient records for appropriate status for eg 23 hr obs vs inpatient, helping process claim denials, creating systems for improved documentation, and is engaged with medical staff, nurses, administration and case management.

Physician advisors work closely with the Chief Medical officer, Chief quality officer, and other hospital leadership.

Sometimes hospitals and healthcare systems consult with outside companies offering external Physician review.

In the setting of large payers and managed care organizations Physicians provide Utilization management services, mostly prospective-before the service has been utilized for example Medication, outpatient testing, etc.

Third-party organizations, called Independent review organizations also utilize Physician advisors as independent contractors as well as full-time employees, and here the utilization review process includes retrospective reviews and in the denial and appeal process.

As a Physician advisor, you can find jobs and create any combination for example mix it up as a clinically active Physician or a full-time Employee with no clinical responsibilities. 

Physician advisors are also a vital part of clinical documentation teams and billing and coding teams offering oversight and review functions. For example, I once came across a Physician advisor role where IRO would contract with consultants like yourself to review documentation of critical access hospitals to ensure JACHO’s regulatory compliances.

Physician advisors are also in a position to educate other Physicians and Providers using their clinical knowledge, strategic thinking, and problem-solving skills.