Sr. Med Director - Physician Advisor

Overview:

The Sr. Medical Director, Physician Advisors provides system-wide physician leadership and oversight for Legacy Health’s Utilization Management (UM), Clinical Documentation Integrity (CDI), and revenue integrity functions. This role is accountable for the strategy, standardization, performance, and direct supervision of the Physician Advisor Program, ensuring alignment across Care Management, Revenue Cycle, HIM/Coding, and medical staff.

 

Acting on behalf of system medical leadership, the Sr. Medical Director exercises independent clinical judgment with organizational impact, guiding medical necessity determinations, documentation integrity, denial prevention, and payer engagement. The role partners closely with executive and operational leaders to improve quality, optimize resource utilization, mitigate regulatory and financial risk, and ensure compliant reimbursement.

 

The Sr. Medical Director serves as the primary physician leader for physician advisory services, establishing standards of practice, driving performance outcomes, and influencing physician practice patterns through data-informed insights, education, and peer leadership.

 

This position reports to the Associate Chief Medical Officer and maintains strong, collaborative alignment with Care Management, Payer strategies and Revenue Cycle leadership to ensure consistent, system-level execution of utilization and revenue integrity.

Responsibilities:

• Establishes and leads the system-wide strategy, standards, and operating model for Physician Advisor services across Utilization Management, Clinical Documentation Integrity, denials/appeals, and revenue integrity.
• Drives consistency and reliability of physician advisor practices through defined standard work, escalation pathways, and performance expectations across all sites and service lines, including service line agreements.
• Partners with Care Management, Payer strategies and Revenue Cycle leadership to align workflows, resources, and priorities to achieve system-level goals in utilization, documentation integrity, and compliant reimbursement.

Qualifications:

Education: Graduate of an accredited U.S. medical school (MD or DO) or equivalent in both the states of WA and OR.

Experience: Minimum seven (7) years of clinical practice and/or physician leadership.

Preferred three (3) years of physician leadership, medical director, or UM/CDI/revenue cycle advisory experience.

 

Skills: Expertise in utilization management, medical necessity, denials/appeals, and clinical documentation integrity. Strong understanding of healthcare finance, revenue cycle operations, and regulatory compliance. Demonstrated leadership, influence, and ability to manage physician teams. Excellent communication and executive-level presentation skills.

Licensure:

Licensure/Certification:

• MD or DO required.
• Unrestricted medical license in applicable states, both Oregon and Washington.
• Board certification in a clinical specialty required.
• Preferred: American College of Physician Advisors certification, American Board of Quality Assurance and Utilization Review Physicians, Certified Healthcare Quality and Management, or the equivalent.

Pay Range: USD $0.00 - USD $0.00 /Hr. Our Commitment to Health and Equal Opportunity:

Our Legacy is good for health for Our People, Our Patients, Our Communities, Our World. Above all, we will do the right thing.

If you are passionate about our mission and believe you can contribute to our team, we encourage you to apply—even if you don't meet every qualification listed. We are committed to fostering an inclusive environment where everyone can grow and succeed.

Legacy Health is an equal opportunity employer and prohibits unlawful discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion or creed, citizenship status, sex, sexual orientation, gender identity, pregnancy, age, national origin, disability status, genetic information, veteran status, or any other characteristic protected by law.

To learn more about our employee benefits click here: www.legacyhealth.org/For-Health-Professionals/careers/benefiting-you