Physician Advisor, Care Progression

Sutter Health

Physician Advisor optimizing health care services and collaborating with healthcare professionals at Sutter Health in Oakland, CA. Focusing on utilization review and regulatory compliance in patient care.

Posted 7/21/2026part-timeOakland • California • 🇺🇸 United StatesMid-LevelSenior💰 $139,214 - $222,747 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Review, medical necessity, and compliance with healthcare regulations while effectively collaborating with healthcare teams and managing patient care processes. Possesses strong interpersonal communication and negotiation skills to optimize resource utilization and enhance patient experiences.

Highest-signal resume keywords

Doctorate DegreeUnrestricted Medical LicenseUtilization Review ExpertiseHealthcare Delivery KnowledgeInterpersonal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewMedical NecessityDocumentation Best PracticesCoding KnowledgeDRG Assignment ProcessLevels of Care KnowledgeHealthcare Reimbursement SystemsClinical ReviewCase ManagementPatient Care Optimization

Soft Skills

Interpersonal CommunicationNegotiation SkillsTime ManagementTeamworkCollaboration

Tools & Technologies

Intermediate Computer Skills

Certifications & Qualifications

MD-Doctor of MedicineDO-Doctor of Osteopathy

Industry Keywords

Healthcare DeliveryManaged Care EnvironmentHealth Maintenance Organization (HMO)Preferred Provider Organization (PPO)Centers for Medicare and Medicaid Services (CMS)Skilled Nursing Facility (SNF)Long Term Acute Care (LTAC)Home HealthHospicePalliative Care

About the role

Key responsibilities & impact

The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and conditions of participation and commercial insurance contracts.
The PA is responsible for establishing, maintaining and strengthening the relationship with System Enterprise and the hospital to appropriately optimize the use of Sutter Health Internal Physician Advisor Services (IPAS).
Conduct clinical reviews on cases referred by UM/CM staff and or other healthcare professionals to meet regulatory requirements in accordance with the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services.
Meet with care management, UM staff and health care team members and medical directors of third-party payers to discuss the needs of patient's and alternative levels of care.
Act as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
Act as a resource for the medical staff regarding federal and state utilization and quality regulations.

Requirements

What you’ll need

Doctorate: Graduate of an accredited medical school
MD-Doctor of Medicine OR DO-Doctor of Osteopathy
Unrestricted medical license in state of residence
3 years of recent relevant experience
Excellent interpersonal communication and negotiation skills
A broad knowledge base of health care delivery and case management within a managed care environment
Comprehensive knowledge of Utilization Review, levels of care, and observation status
Some awareness of healthcare reimbursement systems: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Patient Processing Service (PPS),Centers for Medicare and Medicaid Services (GR) Grouper (CMS) preferred.
Post-acute levels of care such as Home Health, Hospice, Advance Illness Management (AIM), and Palliative Care
Skilled Nursing Facility (SNF), Long Term Acute Care (LTAC), B&C, Sub-acute, Acute rehab
Proficient Knowledge of coding and DRG assignment process preferred
Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners
Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families
Excellent verbal and written communication skills
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities
Intermediate computer skills
Ability to promote teamwork and to effectively function in teams
Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

Benefits

Comp & perks

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