Per Diem Physician Advisor: Utilization & Throughput

St. Joseph's Health; Paterson (NJ); Presencial; USD 207.000 - 317.000; Jornada completa

Descripción de la vacante

St. Joseph's Health in New Jersey seeks an experienced Physician Advisor to join our Utilization Management team in a flexible per-diem capacity.

This role emphasizes clinical leadership to determine patient status, medical necessity, and throughputs while collaborating with physicians, Care Management, Social Work, and payer partners. With up to 6 hours per week, the physician will conduct utilization reviews, apply CMS rules, support denials management, and participate in hospital committees

Formación

• MD or DO from an accredited medical school.
• Minimum 5 years of recent clinical practice experience.
• Strong clinical judgment and communication skills.

Responsabilidades

• Conduct second-level medical necessity and utilization reviews.
• Review observation cases and apply CMS rules 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.

Conocimientos

Clinical judgment

Communication skills

Educación

MD/DO

Descripción del empleo

St. Joseph's Health in New Jersey seeks an experienced Physician Advisor to join our Utilization Management team in a flexible per-diem capacity.

This role emphasizes clinical leadership to determine patient status, medical necessity, and throughputs while collaborating with physicians, Care Management, Social Work, and payer partners. With up to 6 hours per week, the physician will conduct utilization reviews, apply CMS rules, support denials management, and participate in hospital committees