One key area that has evolved is the role of the physician advisor in utilization management. When I began my career in utilization management, medical directors were present but played a much different role, while physician advisors didn’t exist. It was just case manager with screening criteria in hand. Hospitals saw a need for clinicians to be able to support utilization management, and the physician advisor role was created around ten to twelve years ago. Now, physician advisors function as the arbiters of medical necessity and whether they are internal or external to the hospital, they play a crucial role in the review process.