Physician Advisor, Per Diem
Key Skills for This Role
Full Job Posting
Qualifications
- MD or DO from an accredited medical school
- Current or eligible New Jersey physician license
- Minimum of 5 years of recent clinical practice experience
- Strong clinical judgment and communication skills
- Preferred Experience
- Previous Physician Advisor or utilization management experience
- Participation on a Utilization Management/Utilization Review committee
- Knowledge of CMS regulations and the Two-Midnight Rule
- Experience with medical necessity criteria, patient status determination, denials, and appeals
- Understanding of commercial payer requirements
- Familiarity with clinical documentation and documentation improvement
- Experience with length-of-stay and throughput initiatives
- Physician education, coaching, or leadership experience
Responsibilities
- As a Physician Advisor, you will serve as a clinical resource and trusted partner to physicians and hospital teams, helping ensure patients receive the right level of care at the right time while supporting regulatory compliance and appropriate resource utilization.
- Key responsibilities include:
- Conduct second-level medical necessity and utilization reviews
- Review observation cases and apply the CMS Two-Midnight Rule when appropriate
- Perform admission, continued stay, Medicare short-stay, readmission, and pre-/post-bill reviews
- Participate in observation and escalation huddles to support appropriate patient status and timely disposition
- Partner with physicians on medical necessity and clinical documentation
- Perform and support medical necessity appeals and denials management across payers
- Collaborate with Care Management, Social Work, Utilization Review, and hospital leadership
- Communicate with third-party payers when necessary to facilitate approvals and prevent avoidable denials
- Help identify barriers affecting length of stay, discharge, and hospital throughput
- Educate and coach physicians regarding utilization management, documentation, medical necessity, and patient status
- Support organizational quality improvement and utilization management initiatives
- Participate in Utilization Management and other hospital committees as appropriate
- Maintain and expand knowledge of CMS regulations, payer requirements, Joint Commission standards, and New Jersey healthcare regulations
About St. Joseph's Health
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