Physician Advisor

Mount Sinai Services/Elmhurst and Queens Hospital Center; New York (NY); On-site; USD 180,000 - 240,000; Full time

Job summary

Mount Sinai Services/Elmhurst and Queens Hospital Center seeks a full-time Physician Advisor to optimize health care resource use and ensure regulatory and payer compliance. The role involves acting as the physician liaison for utilization, working with case management, finance, and hospital leadership across areas of care progression, level of care, and denial management.

Requirements include an MD/DO, NY license, board certification, and willingness to practice clinically.

Qualifications

• MD/DO degree with NY license and board certification.
• DEA and Medicaid numbers required.
• Willingness to practice clinically in primary specialty.
• Strong foundation in utilization management and quality improvement.
• Familiarity with NYC Health + Hospitals case management operations and medical necessity criteria (MCG/InterQual).

Responsibilities

• Serve as the primary physician liaison for hospital utilization issues.
• Collaborate with case management and finance to optimize resource use and care quality.
• Develop and implement protocols, training, and initiatives for level of care and length of stay.
• Support denial management, documentation, and coding compliance.
• Engage with leadership and staff across departments to improve care and financial sustainability.

Skills

Utilization management

Quality improvement

Data analysis

Communication

Team collaboration

Documentation accuracy

Excel

Epic

Cisco WebEx

Education

MD/DO degree

Board-certified physician

New York State License

DEA & Medicaid numbers

Tools

Epic

Cisco WebEx

Job description

The Icahn School of Medicine at Mount Sinai through its affiliation with New York City Health + Hospitals/Queens is seeking a full-time Physician Advisor to assist with the hospital's goals and objectives for ensuring effective use of health care resources. The Physician Advisor serves as the primary physician liaison for issues pertaining to hospital utilization, including matters pertaining to provider practice patterns, over- and under-utilization of resources, medical necessity, levels of care, care progression and length of stay management, denial management, and compliance with governmental and private payer regulations, physician documentation and coding requirements.

The successful candidate will collaborate closely with case management and finance departments from across the system to identify opportunities, develop methods and implement solutions to optimize use of hospital and system resources in order to optimize quality of care and financial sustainability. In addition, the Physician Advisor will work closely with hospital and medical departmental leadership; frontline medical staff, including attending physician staff, house staff, and advanced practice providers; and other hospital staff across all areas of resource management, case management, social services, and discharge planning, to support the development and implementation of protocols, initiatives, and training programs to optimize level of care, length of stay, supporting documentation, regulatory compliance, hospital coding, and denial management.

Candidates must have an MD or DO degree and be Board-Certified in their respective specialty, with a valid New York State License, DEA and Medicaid number. Must also be willing to work clinically in their primary specialty. A minimum of five years medical practice experience is required. Qualified candidates should possess a solid foundation, knowledge and/or experience in utilization management and quality improvement; acquire knowledge of NYC Health + Hospitals' case management operations; acquire strong familiarity with MCG and Interqual medical necessity criteria; and possess strong computer skills, including proficiency in Microsoft Excel, Epic, and Cisco WebEx. Compensation is competitive and will vary based on specialty, experience, and qualifications.

The Mount Sinai Health System (MSHS) provides equal employment opportunity to all its employees and applicants for employment without unlawful discrimination on the basis of their actual or perceived race, creed, color, religion, national origin, sex, gender, gender expression, gender identity, age, disability, marital or parental status, sexual orientation, veteran, immigration, citizenship, or other protected status.
EOE including Veterans and Disabled