Physician Advisor - Pittsburgh, PA
Highmark Health · Monroeville PA, 15146, 2570 Haymaker Road, United States · hybrid
Company :Allegheny Health NetworkJob Description : Role Overview
AHN’s regional model aligns hospitals within defined geographic markets to strengthen local leadership, operational coordination, and access to consistent network resources and standards. Within AHN East, this Physician Advisor supports both Forbes Hospital and Allegheny Valley Hospital while working with site leaders and network partners to advance shared quality, utilization, and patient-flow priorities.
The Physician Advisor promotes clinically appropriate, cost-effective care by aligning patient needs with regulatory and payer requirements for medical necessity, level of care, and care setting. The role performs level-of-care reviews, supports denial prevention and appeals, and conducts peer-to-peer discussions with payer medical directors. Working closely with physicians, case management, utilization management, nursing, coding, clinical documentation, and hospital leadership, the Physician Advisor also contributes to quality and patient-throughput initiatives and serves as an active member of the Utilization Management Committee. The position reports to the Chief Quality Officer and the Medical Director of Physician Advisors.
Key Responsibilities
- Maintain a regular onsite presence primarily at Forbes Hospital within a hybrid work model, with intermittent presence at Allegheny Valley Hospital focused largely on education and engagement with hospital executive leadership.
- Review admissions, observation services, continued stays, and ancillary services for medical necessity, level-of-care accuracy, and appropriate care setting.
- Collaborate with attending physicians, case managers, utilization management nurses, nursing leaders, and hospital leadership to resolve complex cases and support timely care progression.
- Conduct peer-to-peer discussions with payer medical directors and support authorization, denial prevention, and appeal activities.
- Monitor observation cases, communicate status recommendations, and facilitate established escalation and review processes.
- Participate in interdisciplinary rounds to improve quality, care coordination, throughput, and length of stay.
- Provide clinical expertise and education to medical staff, residents, case management, and utilization management teams on medical necessity, documentation, observation status, and payer requirements.
- Partner with coding and clinical documentation specialists to strengthen documentation accuracy and support appropriate reimbursement.
- Serve as an active member of the Utilization Management Committee and provide physician leadership for case management, observation, and throughput priorities.
- Review performance dashboards, identify trends, and lead action plans when utilization or throughput goals are not met.
Qualifications
Required- MD or DO degree.
- Board certification in a medical specialty or subspecialty.
- At least five years of clinical practice experience in a hospital setting.
- Eligibility for an unrestricted Pennsylvania medical license, with licensure required before employment.
- Ability to obtain and maintain medical staff credentials within Allegheny Health Network.
Preferred- Certification or advanced training in physician advising, healthcare quality, or utilization management.
- Experience as a Physician Advisor in an acute-care setting.
- Experience leading cross-functional work within a large health system.
- Experience working within an integrated payer-provider organization.
What AHN Offers
- Competitive compensation and comprehensive medical benefits.
- Sign-on bonus.
- CME allowance.
- EY financial-planning services, including student-loan and Public Service Loan Forgiveness support.
- 401(k) and 457(b) retirement plans with immediate vesting.
- Malpractice insurance with tail coverage.
- Loan-repayment assistance for qualified candidates.
- A diverse and inclusive workplace.
Why AHN? AHN is an integrated healthcare network with a century-long commitment to exceptional care. Across 14 hospitals, more than 250 care locations, and 3,000+ physicians, AHN combines clinical expertise, innovation, and strategic partnerships to improve the health experience for patients and communities.
Why Pittsburgh? Pittsburgh offers a vibrant, affordable place to live and work, with nationally recognized healthcare innovation, highly regarded universities, diverse neighborhoods, professional sports, a strong culinary scene, and abundant indoor and outdoor activities.
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Carissa Johnston | Physician Recruiter | Carissa.Johnston@ahn.org | 412-527-5941
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