Physician Advisor: Utilization & Care Optimization

Med-Metrix; Parsippany-Troy Hills (NJ); On-site; USD 230,000 - 290,000; Full time

Job summary

Med-Metrix is seeking a Physician Advisor to perform case reviews across all types to ensure compliance and optimize hospital resource use. The role collaborates with medical staff leadership and case management to improve length of stay and appropriate level of care while ensuring documentation and coding accuracy.

The ideal candidate holds board certification and an active US medical license with 3+ years in physician advisory roles, and is proficient with EMR systems and utilization

Qualifications

• Board certification and US license required.
• 3+ years as Physician Advisor with level of care reviews.
• Familiarity with MCG/InterQual criteria preferred.
• Strong knowledge of utilization management and patient safety.
• Proficiency with hospital EMR systems.
• Excellent written and verbal communication skills.

Responsibilities

• Responds to requests for clinical reviews for medical necessity in a timely fashion.
• Provides consultation to attendings, nurses, and case management on complex issues.
• Applies standard criteria (MCG/InterQual) with professional judgment.
• Maintains accountability for achieving case management outcomes.
• Mentions improvements in health record documentation for ICD/DRG.
• Participates in training related to Utilization and Care Management.

Skills

Analytical skills

Communication skills

Interpersonal skills

Problem solving

Microsoft Office

HIPAA knowledge

Education

Board Certified physician

Licensed to practice in US

ABQAURP certifications preferred

Physician Advisor specialization preferred

Tools

EMR systems

Job description

Med-Metrix is seeking a Physician Advisor to perform case reviews across all types to ensure compliance and optimize hospital resource use. The role collaborates with medical staff leadership and case management to improve length of stay and appropriate level of care while ensuring documentation and coding accuracy.

The ideal candidate holds board certification and an active US medical license with 3+ years in physician advisory roles, and is proficient with EMR systems and utilization