Washington, DC19 days ago
Lead Utilization Management and Utilization Review programs to ensure appropriate level of care, regulatory compliance, and optimal resource utilization Serve as Physician Advisor and subject matter expert supporting initiatives to reduce denials and appeals and improve clinical documentation Partner with medical staff and clinical leadership to drive physician and provider engagement, improving accurate, complete, and timely clinical documentation, coding, and billing practices across service lines Collaborate with Revenue Cycle leadership to strengthen financial performance through real-time problem solving, denial reduction strategies, and process improvement Oversee Transitions of Care, including hospital case management and discharge planning, to improve patient throughput, reduce length of stay, and ensure safe care transitions Support alignment between hospital operations and faculty practice plans, advancing integration across service lines in support of the academic mission Provide leadership for quality, patient safety, and performance improvement initiatives that impact utilization, documentation, and reimbursement Serve as a liaison between physicians, administration, nursing, and ancillary departments to foster interdisciplinary collaboration and operational excellence Perform other duties as assigned consistent with the scope of this role. Doctor of Medicine (MD) or Doctor of Osteopathy (DO) required Active, unrestricted medical license required Board certification in a relevant specialty required Minimum of seven to ten (7-10) years of clinical practice experience Minimum of three to five (3-5) years of progressive physician leadership experience (e.g., Medical Director, Physician Advisor, or equivalent) Demonstrated experience leading multidisciplinary teams, including physicians, case management, and administrative staff Demonstrated experience in utilization review, clinical documentation improvement (CDI) programs, and hospital operations Advanced knowledge of utilization management, case management, and CDI practices Expertise in revenue cycle processes, including denial management and payer relations Knowledge of regulatory requirements (CMS, Joint Commission, HIPAA).