Physician Advisor 10Am-6Pm

The Physician Advisor provides clinical expertise to support utilization management, medical necessity, denials management, patient throughput, and quality initiatives. This role partners with physicians, Care Management, Social Work, hospital leadership, and payers to ensure appropriate level of care, resource utilization, regulatory compliance, and timely transitions of care.

Monday-Friday, 10:00 AM-6:00 PM. Occasional weekend or off-hours coverage may be required for time-sensitive issues.

• Graduate of an accredited medical school.
• Minimum five (5) years of recent clinical practice experience.
• Active New Jersey physician license.
• Strong clinical judgment, analytical, communication, and problem-solving skills.

Preferred Qualifications:

• Physician Advisor or Utilization Management experience.
• Experience with denials, appeals, medical necessity reviews, and payer medical directors.
• Knowledge of CMS regulations, Two-Midnight Rule, commercial payer requirements, and clinical documentation.
• Experience with length-of-stay management, patient throughput, and discharge planning.
• Strong physician engagement, teaching, coaching, and presentation skills.
• Perform admission, observation, continued-stay, second-level, short-stay, readmission, and pre-post-bill reviews.
• Evaluate medical necessity and patient status in accordance with CMS requirements, including the Two-Midnight Rule, and commercial payer criteria.
• Support denials management, medical necessity appeals, and payer communications.
• Participate in utilization management, observation, length-of-stay, and escalation activities.
• Identify barriers to discharge and collaborate with Care Management and clinical teams to improve throughput.
• Provide physician education and consultation regarding medical necessity, documentation, level of care, and utilization.
• Participate in Utilization Management and quality improvement committees.
• Support compliance with CMS, New Jersey Department of Health, Joint Commission, and payer requirements.
• Provide clinical guidance and education to medical staff and hospital leadership as needed.