Physician Advisor 10am-6pm
Full Job Posting
Qualifications
- 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.
- 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.
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.
Responsibilities
- 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.
About St. Joseph's Health
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