Physician Advisor 3pm-11pm
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
Apply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at St. Joseph's Health
Medical Secretary II
Wayne, USA
Provides a variety of complex administrative functions for department leaders supporting the primary assigned division and floating to other divisions as required. Is a good critical thinker and can make independent judg
Trauma Program Manager
Paterson, USA
Takes ownership for the organization of services and system resources directed through a multidisciplinary systems approach as stipulated in the American College of Surgeons (ACS) manual on the “Resources for the Optimal
Senior Patient Account Representative
Paterson, USA
Senior Patient Account Representative
Paterson, USA
Medical Secretary II
Wayne, USA
Trauma Program Manager
Paterson, USA
Medical Secretary II
Wayne, USA
Trauma Program Manager
Paterson, USA
Per Diem Clerk Receptionist and Scheduling
Clifton, USA
Dentist - Orthodontics Temp
Paterson, USA