Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. Our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

The Medical Director, Physician Advisor and Utilization Management Program serves as a vital clinical resource advancing care progression, utilization management and documentation quality across City of Hope. This physician leader helps optimize patient flow and length of stay through multidisciplinary collaboration, discharge planning and management of complex admissions. The role leads utilization review activities, supports regulatory and payer compliance, and serves as a trusted liaison between clinical teams and revenue cycle operations. The Medical Director also supports CDI and denials advisory activities as needed. 

As a successful candidate, you will:

• 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.
• Develop and present performance metrics related to utilization review, peer-to-peer outcomes, denial prevention, documentation quality and length of stay.
• Help develop and mature City of Hope’s Physician Advisor Program through workflow refinement, role standardization, best-practice adoption and scalable cross-coverage models.

Your qualifications should include:

• Medical Doctor degree.
• Active membership on a medical staff with at least seven years of experience, including five years in a leadership capacity.
• Current MD or DO license in California.
• Expertise in utilization management, state and federal regulations, and private payer contracts.
• Broad medical and clinical knowledge, with strong communication and interpersonal skills.
• Ability to navigate difficult physician conversations and work effectively with front-line staff and executive leadership.
• Experience with electronic health record systems, InterQual by Optum and Microsoft Office or equivalent productivity tools.
• 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. 

City of Hope employees’ pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.