CDI Physician Advisor

Join City of Hope as a CDI Physician Advisor and Medical Director of the Utilization Management Program, where you will advance care progression, utilization management, and documentation quality across our transformative network. In this vital clinical leadership role, you will help optimize patient flow, lead utilization review activities, and support regulatory and payer compliance. You will also serve as a trusted liaison between clinical teams and revenue cycle operations while collaborating with multidisciplinary partners.

Practice Info

• Hybrid work force type
• Primary location in Duarte, California

Responsibilities

• Lead care progression efforts for short- and long-stay patients, supporting complex discharge planning, appropriate patient placement and efficient transitions.
• Participate in multidisciplinary rounds and help resolve barriers that affect timely progression of care.
• Conduct secondary and second-level utilization reviews, including Two-Midnight Rule, medical necessity, continued stay, HINN and complex admission reviews.
• Determine appropriate admission status and level of care while collaborating with admitting, attending and consulting physicians.
• Co-chair the Utilization Review Committee and help shape agendas, physician engagement, case discussions, regulatory updates and improvement priorities.
• Co-own the enterprise peer-to-peer review process, including case triage, provider preparation, payer engagement, outcome documentation and follow-up.
• Educate physicians and staff on payer requirements, documentation standards, patient placement criteria and utilization management best practices.
• Partner with Case Management, Utilization Review, CDI and Revenue Cycle teams to strengthen escalation pathways, prevent denials and improve documentation quality.

Compensation

• Minimum Hourly Rate ($): 115.9442
• Maximum Hourly Rate ($): 193.6265
• City of Hope employees' pay is based on the following criteria: work experience, qualifications, and work location.

Shift & Schedule

• Shift: Days
• Work Force Type: Hybrid

Requirements

• Medical Doctor degree required.
• Active membership on a medical staff with at least seven years of experience, including five years in a leadership capacity required.
• Current MD or DO license in California required.
• Expertise in utilization management, state and federal regulations, and private payer contracts required.
• Broad medical and clinical knowledge, with strong communication and interpersonal skills required.
• Ability to navigate difficult physician conversations and work effectively with front-line staff and executive leadership required.
• Experience with electronic health record systems, InterQual by Optum and Microsoft Office or equivalent productivity tools required.
• Hospitalist or oncology experience is preferred.
• Familiarity with inpatient and outpatient payer requirements and a demonstrated commitment to quality, safety, efficiency, satisfaction and cost reduction are preferred.
• Master's degree in Business Administration and an interest in teaching others are preferred.