New

Clinical Physician Advisor

Cone Health
United States, North Carolina, Greensboro
Dec 28, 2025
This position acts to ensure the appropriate and efficient medical management of cases while assuring the quality of care is consistent, as it relates to the primary and secondary review process. The candidate will provide guidance on both an individual case and aggregate level to cultivate efficiency related to patient care delivery providing medical case review, utilization and quality review and submit recommendations, advice and liaison services concerning quality and cost-effective patient care. Essential Job Function Reviews medical records of identified patients tassist with the level of care and length of stay determination. Interacts with medical staff members and medical directors of third-party payers tdiscuss the patient needs and alternative levels of care. Provides education tphysicians and other clinicians on regulatory requirements, appropriate utilization of alternate levels of care, community resources and end of life care. Develops strategy and processes treduce denials and audits. Assists with appeals. Reviews and offers suggestions related tresources and service management. Utilizes hospital data sources tidentify and analyze patterns of over or under-utilization of services, quality metrics and makes recommendations towards achievement of those goals. Suggests recommendations of treatment of specific cases and discusses about the same tthe health care team. Acts as consultant and resource tattending physicians regarding their decisions relative tappropriateness of hospitalization, continued stay, and use of resources. Reviews cases retroactively tdetermine appropriateness of Part B billing versus appeal. Education Minimum education required: Licensed Physician MD/DO credentialed from the North Carolina Medical Board. License required and tracked by the local credentialing office ? A bachelor?s degree in chemistry or any related field. ? A four-year degree from an accredited medical school. ? Three to eight years of residency or internship programs. Preferred: ? Board Certified in a Medical and/or Surgical Specialty Active license in any State Physician Advisor Certification from the American College of Physician Advisor preferred Experience Required: Minimum of 5 years inpatient hospital experience; with practice background inclusive of family medicine, internal medicine, or hospitalist medicine Preferred: 5+ years with Specialty practice in Cardiology, Critical care or Surgery Licensure/Certification/Listing REQUIRED Requires Licensed Physician MD/DO credentialed from the North Carolina Medical Board. License required and tracked by the local credentialing office ? A bachelor?s degree in chemistry or any related field. ? A four-year degree from an accredited medical school. ? Three to eight years of residency or internship programs. Preferred: Physician Advisor Certification from the American College of Physician Advisors preferred PREFERRED