Physician Advisor

St. Joseph's Health; Paterson (NJ); On-site; USD 150,000 - 200,000; Full time

Job summary

A healthcare organization in New Jersey is seeking a Physician Advisor to oversee patient care and resource utilization. This role involves conducting medical necessity reviews, managing appeals, and collaborating with various stakeholders to enhance quality outcomes. The ideal candidate must possess strong clinical leadership skills and work primarily Monday to Friday, with potential weekend coverage. This position is crucial for ensuring compliance and optimizing patient throughput.

Responsibilities

• Conduct medical necessity and utilization reviews.
• Manage denials and appeals.
• Advise providers on patient status and documentation.
• Collaborate with Care Management and hospital leadership to improve throughput.

Job description

The Physician Advisor (PA) is a clinical leader responsible for ensuring appropriate patient care, optimizing resource utilization, and maintaining regulatory compliance. The PA conducts medical necessity and utilization reviews, manages denials and appeals, advises providers on patient status and documentation, and collaborates with Care Management and hospital leadership to improve throughput, length of stay, and overall quality outcomes.

The Physician Advisor works primarily Monday–Friday, 10:00 AM – 6:00 PM, with occasional off-hours or weekend coverage as needed to ensure continuity of the Utilization Management program.