Medical Director Physician Advisors - UNCH Care Management Administration

Job Description

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

The Medical Director for Physician Advisors provides strategic and operational oversight for the System Enterprise Services (SES) Physician Advisor Program . This role supports the delivery of high-quality, cost-effective, and safe patient care by aligning clinical practices with regulatory, professional, and organizational standards, in coordination with the Mid-Cycle Revenue Operations System Enterprise Services Division and the System Executive Medical Director for Physician Advisors. The Medical Director for Physician Advisors (“Medical Director”) is responsible for program development, training, scheduling, and management of physicians within the program.

reviewers to function at the level their license expects in their SES roles, and driving continuous improvement in clinical and operational performance.  Key responsibilities include supporting the Utilization Management program, leading efforts in denial management and appeals, and monitoring high-risk audit targets to ensure compliant clinical documentation. The Medical Director also collaborates with experts on Clinical Documentation Integrity (CDI) and coding practices, and actively assists with training peer advisors. [EH1]   [EKMG2]  This role plays a central part in coordinating
and participating in peer-to-peer discussions and appeals for escalated cases, as well as monitoring work queues associated with physician advisor activities, quality initiatives, and other assigned projects.

Responsibilities:
Provides enterprise-wide leadership and strategic direction for the Physician Advisor Program across the System Enterprise Services (SES) hospitals which includes oversight of physician scheduling, training, performance management, and professional development within the advisor team. Ensures clinical practices align with regulatory, professional, and organizational standards, supporting the delivery of safe, high-quality, and cost-effective care.
Collaborates closely with Case Management, Utilization Management, and SES/Executive Physician leadership to enhance concurrent level-of-care coordination, minimize denials, improve documentation, and strengthen payer and physician relationships. This includes operational oversight of peer-to-peer reviews, escalated appeal cases, and medical necessity determinations. Interfaces with third-party payers as needed, addresses authorization or payment discrepancies, and consults with attending physicians to support accurate documentation and service justification.
Supports denial prevention strategies and compliance through timely, complete clinical documentation. Actively partners with CDI and Coding teams to ensure accurate code assignment, DRG validation, quality reporting, and risk adjustment. Oversees utilization review consultations on referred patients, providing timely input on observation, admission, and care decisions when documentation is insufficient.
Plays a central part in evaluating utilization and quality data, working with SES and Executive Physician leaders to implement corrective actions or strategic improvements. Provides regular updates to the System Executive Medical Director, contributes to Utilization Review, Denial, and Audit Committee meetings, and oversight of local UM Committees.
In collaboration with Performance Improvement teams, improves provider performance related to PSIs, service line utilization, and clinical pathway adherence which includes reviewing standing orders, protocols, and utilization benchmarks, as well as leading education sessions, coaching physicians, and mentoring the advisor team. Shares actionable data on trends in resource utilization and denials using these insights to drive targeted improvements across the health system.

Other Information

Education Requirements:
● Graduation from an accredited School of Medicine.
Licensure/Certification Requirements:
● Board certified/eligible physician licensed in the state of North Carolina.
Professional Experience Requirements:
● Requires at least ten (10) years of inpatient physician experience with at least five (5) years of Physician Advisor experience.
Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: STATE

Entity: UNC Medical Center

Organization Unit: UNCH Care Mgmt Administration

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: US: NC:Chapel Hill

Exempt From Overtime: Exempt: Yes

This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.