Council Capital · 1 month ago
Physician Advisor – Utilization Management & Worker's Compensation
Texas
Part-time
Onsite
Senior LevelCouncil Capital is a healthcare-focused private equity firm based in Nashville, Tennessee, managing over $350 million in committed capital. They are seeking a Physician Advisor to lead utilization management, provide clinical oversight, and engage with payers to improve authorization processes.
FinanceHealth CareVenture Capital
Responsibilities
Serve as the primary physician resource for UM decision-making, escalations, and complex case reviews
Provide clinical oversight and guidance for medical necessity determinations
Support concurrent and retrospective review processes as needed
Conduct physician-to-physician reviews with payers to support authorization approvals and overturn denials
Partner with UM and Revenue Cycle teams to improve payer communication strategies
Identify payer-specific trends and opportunities to improve outcomes
Educate providers on documentation best practices tied to medical necessity and payer criteria
Identify recurring documentation gaps and implement corrective guidance
Support audit preparation and response from a clinical perspective
Partner with Case Management, UM leadership, Revenue Cycle, Compliance, and Operations
Provide insights and recommendations based on denial trends and utilization data
Participate in leadership discussions related to utilization strategy and risk mitigation
Qualification
Required
MD or DO with an active, unrestricted medical license
Board Certified in a relevant specialty
Prior experience in Utilization Management, Physician Advisory, Medical Review, or similar role
Strong understanding of medical necessity, payer criteria, and utilization standards
Ability to communicate effectively with both clinicians and non-clinical leaders
Preferred
Experience working with commercial payers and managed care organizations
Prior peer-to-peer review experience with documented success overturning denials
Experience in outpatient, post-acute, or multi-site healthcare services environments
Exposure to healthcare services organizations operating in growth or PE-backed environments
Company
Council Capital
Private equity for healthcare services and healthcare IT that emphasize innovative ways to raise quality and lower costs.
Founded in 2000
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Dennis C Bottorff
Managing General Partner
Grant Jackson
Managing General Partner
Recent News
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