Physician Advisor: Clinical Utilization & Quality Lead

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

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