Physician Advisor: Clinical Utilization and Education

Mohawk Valley Health System; City of Utica (NY); On-site; USD 200,000 - 300,000; Full time

Job summary

Mohawk Valley Health System (MVHS) seeks a Physician Advisor to join our team in New York. The Physician Advisor collaborates with Care Managers and Attending Physicians to align on level of care, patient billing status, and barriers to discharge, while conducting clinical reviews to ensure regulatory compliance and efficient resource use.

The role emphasizes education, guidance, and improving clinical and financial outcomes.

Qualifications

• Active medical staff with > 5 years' experience.
• Broad range of medical/clinical knowledge.
• Expertise in utilization management, state/federal regulations, private payer contracts.
• Good communicator with strong interpersonal skills.
• Willing and able to have "difficult conversations" with physicians.
• Ability to work with front-line staff and executive leadership.
• Propensity for teaching others.

Responsibilities

• Educate and support physician documentation for admission and continued stay, severity, and morbidity/mortality.
• Review patient status when admission criteria is non-sufficient for admission.
• Monitor observation and the application of the 2nd Midnight across payor types (CMS regulation).
• Perform concurrent review and escalation of cases not meeting criteria.
• Provide guidance and advisory services.
• Deliver support associated with palliative care, end-of-life-care and hospice.
• Track and trend outcome KPIs for financial and compliance best practices; provide education based on trends and regulatory changes.
• Must be onsite

Skills

Medical knowledge

Communication skills

Utilization management

Regulatory compliance

Education

Medical Doctor (MD)

MBA

Job description

Mohawk Valley Health System (MVHS) seeks a Physician Advisor to join our team in New York. The Physician Advisor collaborates with Care Managers and Attending Physicians to align on level of care, patient billing status, and barriers to discharge, while conducting clinical reviews to ensure regulatory compliance and efficient resource use.

The role emphasizes education, guidance, and improving clinical and financial outcomes.