Physician Advisor

HURC; Short Hills (NJ); On-site; USD 180,000 - 260,000; Full time

Job summary

HURC seeks a Physician Advisor to lead physician-to-physician reviews and provide clinical guidance across care settings. The role emphasizes evidence-based utilization management and appropriate resource use.

You will collaborate with care teams on medical necessity, CMS rules, and payer guidelines, oversee admission status decisions, and contribute to documentation quality with HIM/CDI partners. A strong background in acute care and peer communication is essential.

Qualifications

• MD or DO with active, unrestricted license.
• Board-certified or board-eligible in a recognized specialty.
• Clinical practice experience in an acute care or relevant healthcare setting.
• Strong knowledge of utilization management, medical necessity, and payer regulations.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct physician-to-physician reviews for medical necessity and level of care.
• Support utilization review, case management, and clinical decision-making.
• Ensure admission status determinations (inpatient vs. observation) align with CMS and payer guidelines.
• Provide clinical oversight on length of stay, care progression, and discharge planning.
• Assist with audits (RAC, MAC, and commercial payer) and documentation processes.
• Partner with HIM/CDI teams to improve documentation quality and clinical accuracy.

Skills

MD/DO license

Board-certified/eligible

Acute care experience

Regulatory knowledge

Communication skills

Education

Medical Doctor (MD)

Job description

The Physician Advisor provides physician-to-physician reviews, clinical guidance, education, and escalation support while promoting evidence-based practices and appropriate resource utilization.

Key Responsibilities

• Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals
• Support utilization review and case management teams with complex clinical decision-making
• Ensure appropriate admission status determinations (inpatient vs. observation) in alignment with CMS and payer guidelines
• Provide clinical oversight related to length of stay, care progression, and discharge planning

• Ensure adherence to CMS Conditions of Participation, Medicare regulations, and payer policies
• Support compliance with medical necessity criteria (InterQual, MCG, or equivalent)
• Assist with audit preparedness and response, including RAC, MAC, and commercial payer audits
• Partner with HIM/CDI teams to improve documentation quality and clinical accuracy

Education & Physician Engagement

• Serve as a trusted peer resource to attending physicians and advanced practice providers
• Educate medical staff on regulatory requirements, utilization best practices, and documentation standards
• Support change management initiatives related to clinical operations and compliance

Qualifications

Required

• MD or DO with an active, unrestricted medical license
• Board-certified or board-eligible in a recognized specialty
• Clinical practice experience in an acute care or relevant healthcare setting
• Strong knowledge of utilization management, medical necessity, and payer regulations
• Excellent communication skills with the ability to conduct peer-to-peer discussions

Preferred

• Prior experience as a Physician Advisor, Medical Director, or in Utilization Review
• Familiarity with CMS guidelines, InterQual, MCG, and denial management processes
• Experience working with case management, CDI, HIM, or revenue cycle teams
• Experience in a remote or consulting healthcare environment

Skills & Competencies

• Physician-to-physician negotiation and collaboration
• Clinical judgment balanced with regulatory and financial awareness
• Data-driven decision-making
• Ability to influence without authority
• Strong written and verbal communication