Medical Director - Physician Advisory Services

Medical Director - Physician Advisory Services

LCMC Health | Louisiana

Lead the Future of Clinical Excellence, Quality, and Care Management

LCMC Health is seeking a highly respected physician leader to serve as our Medical Director, Physician Advisory Services. This strategic role is responsible for advancing utilization management initiatives, supporting quality improvement efforts, optimizing patient care outcomes, and fostering strong collaboration among physicians, care management teams, hospital leadership, and payors.

The Medical Director will serve as a trusted clinical advisor and champion for effective resource utilization, regulatory compliance, physician engagement, and evidence-based practices across the organization.

Position Summary

The Medical Director, Physician Advisory Services provides clinical leadership and oversight for utilization management and care management processes. This role conducts clinical reviews of complex cases, supports medical necessity determinations, leads denial prevention and appeal activities, and collaborates with medical staff and operational leaders to improve quality, patient flow, and healthcare resource utilization.

The ideal candidate is an experienced physician leader with expertise in clinical practice, healthcare quality, utilization management, and physician engagement.

Key Responsibilities

Clinical Review & Utilization Management

• Review cases referred by Care Management and other clinical departments to ensure appropriate utilization of healthcare services and compliance with regulatory requirements.
• Partner with physicians and interdisciplinary teams to identify and address avoidable delays in care and opportunities to improve patient throughput.
• Conduct and document collegial physician interventions related to medical necessity, length of stay, patient status determination, and care progression.
• Participate in High Length of Stay (LOS) reviews and provide clinical guidance to support effective care transitions.

Denials Management & Payor Relations

• Serve as the physician lead for peer-to-peer discussions with payors and external agencies regarding adverse determinations.
• Lead appeals efforts for denied services through physician-to-physician consultation and written clinical review when appropriate.
• Collaborate with payors, patients, and internal stakeholders to resolve utilization and quality concerns.
• Support payor quality reviews and regulatory audits.

Quality & Performance Improvement

• Serve as an active member of the Utilization Management Committee and provide recommendations to improve quality, efficiency, and compliance.
• Analyze utilization and quality data to identify trends, opportunities, and areas requiring focused intervention.
• Review mortality, readmission, and other quality indicators in collaboration with department leadership.
• Present utilization, quality, and performance data to medical staff committees, hospital leadership, and governing bodies.
• Assist in the development and implementation of evidence-based practice guidelines and performance improvement initiatives.

Physician Leadership & Education

• Educate and mentor physicians regarding documentation best practices, medical necessity standards, utilization management principles, and regulatory requirements.
• Support medical staff engagement and physician alignment initiatives.
• Collaborate with hospital leadership, department chairs, and quality teams to advance organizational goals and improve patient outcomes.

Qualifications

Required

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
• Current unrestricted Louisiana medical license or eligibility for Louisiana licensure
• Minimum of five (5) years of clinical practice experience
• Demonstrated leadership, communication, and relationship-building skills
• Strong knowledge of healthcare quality, patient safety, and care management principles

Preferred

• Previous Physician Advisor experience
• Experience in Utilization Management, Care Management, Case Management, or related healthcare leadership roles
• Experience serving on a Utilization Management Oversight Committee or similar governance committee
• Familiarity with CMS regulations, medical necessity criteria, denial management, and healthcare reimbursement processes

deal Candidate

The successful candidate will be:

• A collaborative physician leader who can influence positive change across multiple stakeholders.
• Skilled in balancing quality outcomes, patient experience, regulatory compliance, and operational efficiency.
• Passionate about improving care delivery through data-driven decision making and clinical excellence.
• Effective at engaging physician colleagues through education, partnership, and mentorship.

Why Join LCMC Health?

At LCMC Health, we're committed to delivering extraordinary care and building healthier communities throughout Louisiana. As the Medical Director, Physician Advisory Services, you will have the opportunity to influence clinical practice, improve patient outcomes, strengthen physician engagement, and drive meaningful organizational impact.

Join us in shaping the future of healthcare quality, utilization management, and patient-centered care.