Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Bala Cynwyd, Pennsylvania

Description Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Entity:

Corporate Services Department:

Corp Utilization Management Location:

HUP/ hybrid

Summary:

The Physician Advisor serves as a key clinical leader within Utilization Management (UM), reporting to the AVP of Utilization Management and working in close partnership with the Lead to support appropriate patient status determinations, medical necessity review, and regulatory compliance. This role provides timely clinical consultation to UM, Case Management, and medical staff to promote accurate level-of-care decisions and effective use of healthcare resources. In collaboration with the Lead and interdisciplinary partners, the Physician Advisor supports physician education, case escalation, documentation improvement, and denial prevention efforts across the continuum of care. Through case review, peer-to-peer engagement, and alignment with organizational and payer requirements, this role contributes to efficient care progression, improved patient outcomes, and strong operational and financial performance.

Responsibilities:

Provide clinical oversight and consultation regarding admission status, level of care, medical necessity, and compliance with regulatory and payer requirements. Conduct secondary reviews, support escalation of complex or disputed cases, and partner with the Lead and UM leadership to resolve barriers and promote consistent decision-making. Participate in peer-to-peer discussions, denial prevention activities, and appeal support to strengthen payer outcomes and reduce avoidable denials. Educate physicians, advanced practice providers, and UM/CM teams on documentation standards, admission criteria, medical necessity expectations, and compliant utilization practices. Collaborate with Case Management, Social Work, CDI, Coding, HIM, Revenue Cycle, and operational leaders to improve care progression, patient flow, and reimbursement accuracy. Identify and communicate trends in denials, documentation gaps, utilization patterns, and length-of-stay opportunities, and support performance improvement initiatives led by UM leadership. Participate in assigned projects, committees, and organizational initiatives, and perform responsibilities in accordance with Penn Medicine and entity values, policies, and procedures. Performs duties in accordance with Penn Medicine and entity values, policies, and procedures. Other duties as assigned to support the unit, department, entity, and health system organization.

Credentials:

Must be a PA State Licensed Medical Doctor or Doctor of Osteopathic Medicine (Required).

Education or Equivalent Experience:

MD or DO is required. 5+ years of clinical experience in a hospital setting is required. 3+ years of knowledge of information technology including statistical analysis, medical informatics and electronic medical record documentation & clinical protocols is required. Possess or develop a solid foundation in the areas of utilization management and hospital operations is required. We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. Live Your Life's Work We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.