Physician Advisor 3pm-11pm

St. Joseph's Health; Paterson (NJ); In loco; USD 160.000 - 210.000; Tempo pieno

Descrizione del lavoro

St. Joseph's Health in New Jersey is seeking a Physician Advisor to provide clinical expertise for utilization management, medical necessity reviews, and denials management. You will collaborate with physicians, Care Management, and leadership to ensure appropriate level of care and timely transitions of care.

The role supports compliance with CMS and payer requirements and offers opportunities to educate clinical staff while improving throughput and patient outcomes.

Competenze

• Graduate of an accredited medical school with active clinical experience.
• Minimum five years of recent clinical practice in a hospital setting.
• Strong clinical judgment, analytical mindset, and effective communication.

Mansioni

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

Conoscenze

Clinical judgment

Analytical skills

Communication skills

Problem-solving

Denials & appeals experience

CMS regulations knowledge

Formazione

Graduate of an accredited medical school

Minimum five years of clinical practice

Descrizione del lavoro

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.

Schedule:
Monday–Friday, 3:00 PM–11:00 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.