A day in the life of a hospital-based Utilization Review Physician Advisor

A day in the life of a hospital-based Utilization Review Physician Advisor can vary depending on the specific responsibilities of the role and the needs of the healthcare facility. The work a physician advisor does is purely dependent on how the job is structured. I work for a hospital currently and I worked for a company that does UM work for hospitals, and so I can share what a typical day looked like for me in these two different roles.

  1. Here’s a general overview of what I do on a regular day for my Main Physician Advisor job for our hospital:

7am: I start my work at 7am. Initially, I tend to prepare for P2P reviews that are scheduled for the day if I could not prepare the previous day. I start getting texts from our UM nurses with denials from Medical Directors of commercial payers. I review one after another and either accept or decide to do peer to peer review. If I decide to do P2P on a patient, I text our UM nurse to arrange one for me. We can ask for P2P reviews either on the same day or the next day. I do some P2Ps the same day and some the next day if I have too many. This keeps going on until I am done with all reviews of denials. I keep getting denials through the whole day actually but sometimes, it slows down.

12pm: Lunch time.

After lunch time, I go through the lists of patients for the two hospitals we cover and look for possible upgrades from observation to Inpatient status. I won’t be able to describe in detail everything I do though.

During the whole day, I keep reaching out to the rounding physicians in the hospital if I have any questions about the plan of care or if I have any status changes that they need to approve.

During this work, I may sometimes search for CPT codes to look if a particular surgical procedure is listed in Medicare Inpatient Only list or not.

There are multiple UM nurses who work for our hospitals and we get multiple texts on a daily basis.

My work usually ends around 630pm to 7pm.

As there are no denials received in the weekend, work is definitely easier in the weekends.

Every few weeks, probably monthly, we have a meeting with all the UM committee members. We also meet among our Physician Advisors on a conference call to discuss our experiences and learn from each other. We all like this meeting as we get to share some good tips from each other.

2. Here’s a general overview of what I did on a regular shift for the Part Time Physician Advisor job for a company:

I worked for a company which supports UM work for hospitals. They have Full time and Part time physician advisors. Full time physician advisors do status determinations and peer to peer reviews.

I worked as a part time employee for that company. I used to write status determination letters for them. They have a software that pulls all the information from patients’ charts, and we are given access to that. We write status letters based on the templates they gave us. I am unable to share those templates, but I am sure you will get access to those if you are hired by any such company.

The system automatically assigns a new case as soon as we are done writing status letters for a case. They offered 3hr, 4hr, 5hr, 6hr and 8hr shifts for part time Physician Advisor work.