Physician Advisor (Clinical Assistant Professor, HS)

SUNY Downstate Health Sciences University; New York (NY); On-site; USD 275,000 - 325,000; Full time

Job summary

SUNY Downstate Health Sciences University invites applications for the Physician Advisor role in New York. This full-time position centers on medical necessity review, utilization management, and quality improvement, reporting to the Chief Medical Officer. Part-time inquiries may be considered.

Total compensation ranges from $275,000 to $325,000 annually. The role emphasizes collaboration with care teams, education on documentation and regulatory standards, and leadership of the Utilization

Qualifications

• Medical knowledge of utilization management principles and regulatory requirements.
• Strong analytical skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Responsibilities

• Utilization Review: review medical records to assess appropriateness and compliance.
• Medical Necessity Determination: evaluate procedures and level of care.
• Optimizing Discharge Planning: collaborate to improve length of stay and resource use.
• Denial Management: lead appeals with education on documentation and ICD-10 coding.
• Education and Training: teach utilization management concepts to staff.
• CDI collaboration: ensure accurate physician documentation to improve metrics.
• Intradisciplinary Collaboration: coordinate with physicians, nurses, and admins.
• Policy Development: contribute to policies and procedures for UM.
• Leading the Utilization Management Committee.
• Performance Monitoring: track KPIs for UM, quality, and financial outcomes.
• Clinical duties: up to 25% of the position.
• Perform other duties as assigned by the CMO.

Skills

Analytical skills

Communication skills

Independent and collaborative work

Utilization management knowledge

Education

Medical degree (MD or DO)

Job description

Job Description

The Physician Advisor plays a critical role in optimizing healthcare delivery by providing guidance on medical necessity, utilization management, and quality improvement initiatives. They collaborate with healthcare teams to ensure compliance with regulatory standards and promote cost-effective care delivery. This is a full-time position reports to the Chief Medical Officer. Candidates can inquire about part-time availability.

Job Description

The Physician Advisor plays a critical role in optimizing healthcare delivery by providing guidance on medical necessity, utilization management, and quality improvement initiatives. They collaborate with healthcare teams to ensure compliance with regulatory standards and promote cost-effective care delivery. This is a full-time position reports to the Chief Medical Officer. Candidates can inquire about part-time availability.

Key Functional Duties

• Utilization Review: Review medical records and documentation to assess the appropriateness of services rendered and ensure compliance with regulatory guidelines.
• Medical Necessity Determination: Evaluate the medical necessity of procedures, treatments, and hospital admissions/level of care (Inpatient vs. observation) based on established criteria and guidelines.
• Optimizing Discharge Planning: Collaborate with case managers, Social works, and healthcare providers to develop care plans that meet patients' clinical needs while optimizing resource utilization to improve Length of Stay. Work with the other stakeholders to optimize IDR
• Denial Management: Lead the denial appeal process to optimize the resolution of insurance denials by providing clinical expertise and supporting appeals processes. The Physician advisor will identify trends in denial cases, perform root cause analysis, and develop actionable plans to prevent future denials. This includes providing targeted physician education on documentation best practices and ensuring alignment with appropriate ICD-10 coding and medical necessity criteria
• Education and Training: Provide education and training to healthcare professionals on utilization management principles, documentation requirements, and regulatory compliance.
• CDI: Collaborate with CDI to ensure appropriate physician documentation with a goal to improve utilization, CMI, and risk adjusted quality measures
• Intradisciplinary Collaboration: Work closely with physicians, nurses, administrators, and other stakeholders to promote effective communication and coordination of care.
• Policy Development: Contribute to the development and revision of utilization management policies, protocols, and procedures.
• Leading the Utilization Management Committee
• Performance Monitoring: Monitor and evaluate key performance indicators related to utilization management, quality of care, and financial outcomes.
• Clinical duties: up to 25% of the position
• Perform other duties as assigned by the CMO

Total compensation of $275,000 - $325,000.

Qualifications

Required Qualifications

• Medical degree (MD or DO)
• Medical license
• Knowledge of utilization management principles, regulatory requirements, and healthcare economics.
• Strong analytical skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Preferred Qualifications

• Experience with electronic health records (EHR) and healthcare information systems.
• Clinical experience in a hospital or healthcare setting.

About Us

Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.

About The Team

Executive Order

Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at [phone] or via email at [e-mail].

Equal Employment Opportunity

SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.

Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.

If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at [e-mail].