Physician Advisor and CMIO Role

About the role

The Physician Advisor (PA) and Chief Medical Information Officer (CMIO) provides physician leadership for patient‑care utilization, documentation, coding, and compliance across the health system. Reporting to the System Medical Director of Utilization, the PA partners with clinical, administrative, and revenue‑cycle teams to improve length of stay, ensure appropriate level‑of‑care decisions, and support quality initiatives.

Key responsibilities

• Collaborate with physicians, case managers, coding, revenue cycle, and payors to resolve utilization issues and ensure appropriate resource use.
• Respond to clinical review requests for medical necessity and provide timely guidance.
• Participate in concurrent peer‑to‑peer appeals, denials, and discharge planning discussions.
• Educate clinical and non‑clinical staff on utilization criteria, coding guidelines, and regulatory requirements.
• Maintain access to utilization reports, federal and state regulations, and disseminate relevant information to hospital staff.

Required profile

• Member of the American College of Physician Advisors (ACPA) or board‑certified by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or commitment to obtain such certification.
• Proven ability to build rapport with medical staff and hospital leadership.
• Strong communication skills for challenging conversations.
• Experience in utilization management (preferred) and familiarity with medical literature, reimbursement issues, MCG/InterQual criteria, and Medicare/Medicaid compliance.

Required skills

• Working knowledge of electronic medical record (EMR) systems.
• Advanced computer proficiency.
• Understanding of coding and level‑of‑care determination tools.