Care Management & Utilization Management Physician Advisor

ACPM; City of White Plains (NY); On-site; USD 180,000 - 260,000; Full time

Job summary

White Plains Hospital in White Plains, NY seeks an experienced Care Management & Utilization Management Physician Advisor to provide clinical leadership across care management, utilization management, CDI, coding, quality, and patient safety. This full-time role drives high-value, evidence-based care and ensures regulatory compliance while guiding hospital operations.

You will partner with interdisciplinary teams to optimize admission decisions, documentation accuracy, and transitions of care,

Qualifications

• MD/DO from an accredited medical school.
• Current, unrestricted New York State medical license.
• Board certification in a medical specialty.
• Minimum of 10 years of clinical practice with progressive physician leadership experience.
• Hospital-based or inpatient clinical experience preferred.
• Experience in Physician Advisory, Care Management, Utilization Management, CDI, Coding, Quality, Patient Safety, or hospital operations preferred.
• Experience with medical necessity, inpatient/observation status, payer peer-to-peer reviews, denials and appeals preferred.
• Experience with multidisciplinary performance improvement and physician engagement.

Responsibilities

• Provide physician leadership and clinical guidance across Care Management, Utilization Management, CDI, Coding, Quality, Patient Safety, and hospital operations.
• Support admission status decisions and level of care determinations.
• Participate in payer peer-to-peer reviews, denials, appeals, and complex case escalations.
• Collaborate with CDI and Coding teams to support accurate documentation and coding.
• Improve care progression, length of stay, transitions of care, and discharge planning.
• Identify opportunities to improve quality, patient safety, and resource utilization.
• Educate and engage physicians on documentation, utilization, medical necessity, and regulatory requirements.
• Lead multidisciplinary performance-improvement and physician engagement initiatives.

Skills

Physician leadership

Interdisciplinary collaboration

Regulatory compliance

Data-driven decisions

Influencing physicians

Education

MD/DO

New York medical license

Board certification

Tools

None

Job description

White Plains Hospital, White Plains, Westchester, New York

White Plains Hospital is seeking an experienced Care Management & Utilization Management Physician Advisor to provide physician leadership across Care Management, Utilization Management, Clinical Documentation Integrity, Coding, Quality, Patient Safety, and hospital operations.

This is a hospital-wide physician leadership role focused on supporting high-quality, efficient, patient-centered care while ensuring appropriate utilization, medical necessity, care progression, accurate clinical documentation, and regulatory compliance. The Physician Advisor will serve as a trusted resource for physicians and interdisciplinary teams in addressing complex clinical and operational issues.

Key Responsibilities

• Provide physician leadership and clinical guidance across Care Management, Utilization Management, CDI, Coding, Quality, Patient Safety, and hospital operations.

• Support appropriate admission status, inpatient versus observation determinations, level of care, medical necessity, and continued stay decisions.

• Participate in payer peer-to-peer reviews, denials, appeals, and complex case escalations.

• Partner with CDI and Coding teams to support accurate, complete, and clinically supported documentation and coding.

• Collaborate with physicians and interdisciplinary teams to improve care progression, length of stay, transitions of care, and discharge planning.

• Identify opportunities to improve quality, patient safety, clinical outcomes, readmissions, and resource utilization.

• Support initiatives to reduce unwarranted clinical variation and promote evidence-based, high-value care.

• Use clinical, operational, utilization, quality, and financial data to identify opportunities and measure improvement.

• Educate and engage physicians regarding documentation, utilization, medical necessity, regulatory requirements, and evidence-based practice.

• Lead and participate in multidisciplinary performance-improvement, quality, and physician engagement initiatives.

• Collaborate with hospital leadership and key departments to address complex clinical, operational, and patient-care issues.

Qualifications

• MD or DO from an accredited medical school.

• Current, unrestricted New York State medical license.

• Board certification in a medical specialty.

• Minimum of 10 years of clinical practice with progressive physician leadership experience.

• Significant hospital-based or inpatient clinical experience preferred.

• Experience in Physician Advisory, Care Management, Utilization Management, Clinical Documentation Integrity, Coding, Quality, Patient Safety, or hospital operations preferred.

• Experience with medical necessity, inpatient/observation status, payer peer-to-peer reviews, denials and appeals strongly preferred.

• Experience with multidisciplinary performance improvement and physician engagement.

• Strong communication, collaboration, problem-solving, and conflict-resolution skills.

• Ability to influence and engage physicians and interdisciplinary teams without formal authority.

Schedule

Full-time: In person 40 hours Monday-Friday

This is primarily a hospital-based physician leadership position with regular interaction with physicians, clinical teams, Care Management, CDI, Coding, Quality, Patient Safety, and hospital leadership.

Why White Plains Hospital?

White Plains Hospital is a leading healthcare provider in Westchester County and part of the Montefiore Health System. As the organization continues to grow, we are investing in our facilities, clinical programs, technology, and people to meet the evolving healthcare needs of the community.

The Physician Advisor will have an opportunity to play an important role in supporting clinical excellence, operational performance, and the continued growth of the organization.

White Plains Hospital is an Equal Opportunity Employer.

We are committed to providing equal employment opportunities to all qualified individuals without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other status protected by applicable law.