Baylor College of Medicine and Department Summary:

The Section of General Internal Medicine at Baylor College of Medicine is dedicated to excellence in patient care, education, scholarly activities, and community engagement. As general internists, we apply scientific knowledge, clinical expertise and compassion to prevention, screening, diagnosis, and treatment of adult patients with a broad spectrum of medical conditions. We care for diverse patients in primary care outpatient settings as well as hospitalized patients. Our collaborative interdisciplinary teams practice at Baylor Medicine Clinic, Baylor St. Luke's CHI Hospitals (Medical Center, Sugarland, Vintage, Woodlands), Harris Health System (Ben Taub Hospital and Smith Clinic) and Michael E. DeBakey Veterans Affairs Medical Center.

Summary

The Section of General Internal Medicine at Baylor College of Medicine is seeking a Physician Advisor to provide services at Baylor St. Luke's Medical Center. The ideal candidate serves as an in-person clinical resource and liaison between the medical staff, hospital administration, and case management to support best practices in utilization management, clinical documentation, compliance, and quality of care.

Job Duties

• Provide expert guidance to ensure clinical care, documentation, and utilization align with CMS regulations, Conditions of Participation (CoPs), and hospital compliance standards.
• Support Case Management (CM), Utilization Management (UM), and Clinical Documentation Integrity (CDI) teams through secondary case reviews, troubleshooting, and physician education.
• Act as a liaison and peer educator for medical staff, translating regulatory and documentation requirements into actionable clinical practice improvements.
• Collaborate with hospital leadership and clinical committees to design and implement processes that enhance patient care quality, efficiency, and resource stewardship.
• Serve as Chair of the Utilization Review Committee, providing administrative and clinical oversight on utilization and documentation issues.
• Resolve complex cases involving delays in care, medical necessity determinations, or provider non-response by directly engaging with physicians and departmental teams.
• Assist in denial management and appeal processes, including peer-to-peer reviews and analysis of clinical validation denials from payors.
• Drive improvements in documentation quality and financial performance, impacting metrics like Length of Stay (LOS), Case Mix Index (CMI), and reduction of avoidable days and denials.
• Monitor and influence key performance metrics, such as length of stay, avoidable days, condition code 44s, and query response rates, while supporting financial performance through appropriate status assignments and diagnosis capture.

Benefits include malpractice insurance, comprehensive medical/vision/dental coverage, retirement, funds for CME related activities, and shared administrative support.

Minimum Qualifications

• M.D. or D.O. with an active, unrestricted medical license.
• Board certification in internal medicine.
• Minimum of 5 years clinical practice experience (hospital-based preferred).
• Experience in utilization management, physician advising, or care management preferred.
• Strong knowledge of CMS regulations, medical necessity criteria, and hospital operations.
• Excellent communication, interpersonal, and leadership skills.

Preferred Qualifications:

• Certified Physician Advisor: CHCQM-PHYADV or ACPA-C
• Experience with Epic
• Prior experience in a large hospital or health system.