Physician Advisor 10am-6pm

St. Joseph's Health; Paterson (NJ); On-site; USD 140,000 - 200,000; Full time

Job summary

St. Joseph's Health seeks a Physician Advisor to provide clinical expertise in utilization management, medical necessity reviews, and denials management. You will collaborate with physicians, Care Management, Social Work, hospital leadership, and payers to ensure appropriate care levels and regulatory compliance.

The role supports throughput and timely transitions of care, with daily hours Monday–Friday and occasional extra coverage for time-sensitive issues.

Qualifications

• Strong clinical judgment, analytical, communication, and problem-solving skills.
• Experience in utilization management, payer communications, and clinical guidance.

Responsibilities

• Perform admission, observation, continued-stay, readmission and pre-post-bill reviews.
• Evaluate medical necessity and patient status per CMS and payer criteria.
• Support denials management, medical necessity appeals, and payer communications.
• Participate in utilization management, observation, length-of-stay, and escalation activities.
• Identify barriers to discharge and collaborate to improve throughput.
• Provide physician education and consultation on medical necessity and documentation.
• Participate in Utilization Management and quality improvement committees.
• Support CMS, NJDOH, Joint Commission, and payer regulatory compliance.
• Provide clinical guidance and education to medical staff and leadership as needed.

Skills

Clinical judgment

Analytical

Communication

Problem-solving

Education

Medical degree from an accredited medical school

Job description

The Physician Advisor provides clinical expertise to support utilization management, medical necessity, denials management, patient throughput, and quality initiatives. This role partners with physicians, Care Management, Social Work, hospital leadership, and payers to ensure appropriate level of care, resource utilization, regulatory compliance, and timely transitions of care.

Monday–Friday, 10:00 AM–6:00 PM. Occasional weekend or off-hours coverage may be required for time-sensitive issues.

Responsibilities

• Perform admission, observation, continued-stay, second-level, short-stay, readmission, and pre-post-bill reviews.
• Evaluate medical necessity and patient status in accordance with CMS requirements, including the Two-Midnight Rule, and commercial payer criteria.
• Support denials management, medical necessity appeals, and payer communications.
• Participate in utilization management, observation, length-of-stay, and escalation activities.
• Identify barriers to discharge and collaborate with Care Management and clinical teams to improve throughput.
• Provide physician education and consultation regarding medical necessity, documentation, level of care, and utilization.
• Participate in Utilization Management and quality improvement committees.
• Support compliance with CMS, New Jersey Department of Health, Joint Commission, and payer requirements.
• Provide clinical guidance and education to medical staff and hospital leadership as needed.

Qualifications

• Graduate of an accredited medical school.
• Minimum five (5) years of recent clinical practice experience.
• Strong clinical judgment, analytical, communication, and problem-solving skills.

Preferred Qualifications:

• Experience with denials, appeals, medical necessity reviews, and payer medical directors.
• Knowledge of CMS regulations, Two-Midnight Rule, commercial payer requirements, and clinical documentation.
• Experience with length-of-stay management, patient throughput, and discharge planning.
• Strong physician engagement, teaching, coaching, and presentation skills.