SmarterDx · 3 hours ago
Physician Advisor, Utilization Management
United States
Full-time
Remote
Senior Level
$240K/yr - $290K/yrSmarterDx is a company that builds clinical AI transforming how hospitals translate care into payment. The Physician Advisor, Utilization Management will work closely with Product and Data Science teams to apply physician judgment in developing clinical logic and workflows that support level-of-care decisions.
Artificial Intelligence (AI)Health CareHospitalInformation Technology
Responsibilities
Review and refine AI-generated clinical summaries and indicators related to medical necessity, level of care, and patient status, ensuring outputs reflect real-world physician reasoning and defensibility
Collaborate with Product and Data Science teams to define and validate clinical logic that surfaces relevant evidence and highlights potential status misalignment
Translate clinical knowledge into prompts and guidelines for large language models
Apply a physician advisor perspective to help model clinical gray areas where documentation quality, acuity, and trajectory matter most
Support the design of UM workflows that assist nurses and physician advisors in efficiently reviewing cases without directing clinical decisions
Translate utilization review standards, regulatory guidance, and clinical judgment into clear product requirements and clinical guidelines for level of care determinations
Serve as a clinical subject matter expert for level of care determinations, escalation pathways, and payer-facing documentation expectations
Qualification
Required
Physician background with experience in utilization management, physician advisory work, or medical necessity review in an acute care setting
Strong understanding of how level-of-care decisions are evaluated, escalated, and defended over the course of a hospital stay
Deep knowledge of CMS 2-Midnight Rule, Condition Code 44, OC72, and related inpatient/outpatient guidelines
Familiarity with tools such as InterQual® or MCG® and EMR-based workflows for utilization review and patient tracking
Prior experience, or strong interest, in advising healthcare technology companies and building systems to support real-time utilization review
Comfort operating in clinical gray areas where criteria are not definitive and documentation quality materially impacts outcomes
MD or DO
Direct experience performing physician advisory work, or medical necessity determinations
Direct experience participating in peer-to-peer reviews with payers
Direct experience overseeing care for hospitalized patients
Ability to clearly articulate clinical reasoning and translate it into structured logic
Comfort working in a non-clinical, product-focused role
Preferred
Prior experience with AI prompt engineering
Previous advising or consulting experience with healthcare technology companies
Experience working with or overseeing physician advisor teams or UM teams
Familiarity with denial management related to medical necessity or level of care
Benefits
Medical, Dental & Vision – Comprehensive plans with leading insurance providers, covering 75% of your premiums, depending on the plan.
Paid Parental Leave – Generous paid leave to support families through birth or adoption: Up to 12 weeks for parents.
Remote-First Team – Work from anywhere in the U.S.
Unlimited PTO & 10 Holidays – So you can relax and recharge.
401(k) with Traditional & Roth Options – Tax-advantaged retirement savings through Fidelity with a 4% match.
Minimal Bureaucracy – A fast-moving, high-impact environment where you can focus on what matters.
Incredible Teammates! – Work alongside smart, supportive, and mission-driven colleagues.
Company
SmarterDx
SmarterDx is a clinical AI company that develops automated pre-bill review technology to assist hospitals in analyzing patient discharges.
Founded in 2020
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
$55.97MKey Investors
New Mountain CapitalTransformation CapitalFlare Capital Partners,Floodgate
2025-04-14Private Equity
2025-04-14Acquired
2024-05-14Series B· $50M
Leadership Team
Michael Gao
CEO, Co-Founder
Joshua Geleris
Co-Founder, Head of Product
Recent News
2025-10-24
Business Insider
2025-10-23
Business Insider
2025-10-23
Company data provided by crunchbase