Physician Advisor: Utilization & Care Optimization

Med-Metrix, LLC; Parsippany-Troy Hills (NJ); Remote; USD 130,000 - 180,000; Full time

Job summary

Med-Metrix, LLC in Parsippany-Troy Hills, NJ seeks a Physician Advisor to perform case reviews across all types to maximize compliance and optimize hospital resource use. This role emphasizes critical thinking, medical knowledge, and collaboration with the medical staff leadership.

You will work closely with clinical teams to support documentation, coding improvements, and utilization management while ensuring the highest standards of patient care and safety.

Qualifications

• Board certification and US medical license required.
• 3+ years as Physician Advisor with Level of Care and Peer-to-Peer Reviews.
• Proficiency with hospital EMR systems and strong MS Office skills.
• Familiarity with utilization management, quality improvement, and patient safety.

Responsibilities

• Respond to clinical reviews for medical necessity and other needs within Case Management.
• Provide consultation to attendings, nurses, and staff on justification for continued stay and utilization management.
• Apply standard criteria (MCG/InterQual) with professional judgment and patient variables.
• Support clinical progression and documentation quality for accurate ICD/DRG coding.
• Educate physicians on payer requirements and participate in peer reviews as requested.
• Maintain HIPAA compliance and protect PHI at all times.
• Attend meetings with PAOC leadership and contribute to organizational goals.

Skills

Analytical skills

Communication skills

Interpersonal skills

Problem solving

Decision making

Presentation skills

Microsoft Office

EMR proficiency

Education

Medical license in the US

Board certification in medicine

Tools

Hospital EMR systems

Microsoft Office Suite

Job description

Med-Metrix, LLC in Parsippany-Troy Hills, NJ seeks a Physician Advisor to perform case reviews across all types to maximize compliance and optimize hospital resource use. This role emphasizes critical thinking, medical knowledge, and collaboration with the medical staff leadership.

You will work closely with clinical teams to support documentation, coding improvements, and utilization management while ensuring the highest standards of patient care and safety.