Physician Advisor: Utilization & CDI Leader

AtlantiCare; Atlantic City (NJ); On-site; USD 250,000 - 450,000; Full time

Benefits offered by this job

Generous PTO

Medical, Prescription Drug, Dental & V

Vision Insurance

Retirement Plans with employer contrib

Disability Coverage

Tuition Reimbursement

FSAs

Wellness Programs

Voluntary Benefits

Job summary

AtlantiCare seeks a Physician Advisor to partner with multi-disciplinary teams to ensure medical necessity, appropriate level of care, and compliant documentation for acute-care and observation services. You will guide regulatory and payer requirements while educating clinicians and leading CDI initiatives.

The role emphasizes collaboration with Care Management, CDI, Coding, Quality, and hospital leadership to optimize outcomes and reimbursement.

Qualifications

• MD or DO from an accredited medical school.
• Board certification in a clinical specialty; healthcare quality or physician advising preferred.
• Minimum five years of recent clinical practice; acute-care experience preferred.
• Working knowledge of utilization management, CDI, coding and reimbursement.
• Experience with evidence-based criteria such as MCG or InterQual; proficient with electronic health records.

Responsibilities

• Conduct concurrent and retrospective medical record reviews to evaluate medical necessity and level of care.
• Lead denial prevention and appeal strategy with physician leadership for payer disputes and appeals.
• Provide timely physician-to-physician consultation to care team members.
• Lead CDI/clinical validation initiatives to promote accurate documentation and compliant coding.
• Review DRG assignment, SOI, and mortality trends to improve documentation and reimbursement.
• Develop and deliver targeted physician education on medical necessity, UM, CDI, and regulatory changes.
• Collaborate with Quality, CDI, Coding, and clinical leadership on improvement initiatives.
• Chair the CDI Steering Committee and coordinate improvement initiatives across service lines.
• Analyze performance metrics and present findings to medical staff and leadership.
• Ensure adherence to regulatory and payer requirements in documentation and status determinations.

Skills

Analytical thinking

Clinical judgment

Communication skills

Change management

Regulatory knowledge

Education

MD or DO

Board certification

Tools

Electronic Health Records

Clinical documentation systems

Job description

AtlantiCare seeks a Physician Advisor to partner with multi-disciplinary teams to ensure medical necessity, appropriate level of care, and compliant documentation for acute-care and observation services. You will guide regulatory and payer requirements while educating clinicians and leading CDI initiatives.

The role emphasizes collaboration with Care Management, CDI, Coding, Quality, and hospital leadership to optimize outcomes and reimbursement.