Physician Advisor - Utilization, Compliance & Care Optimization

Mount Sinai Hospital; Hempfield Township (Westmoreland County); On-site; USD 180,000 - 280,000; Full time

Job summary

Mount Sinai Hospital is seeking a full-time Physician Advisor to support hospital utilization, including provider practice patterns, resource use, and medical necessity decisions.

The role requires an MD or DO, board certification, NY license, DEA and Medicaid numbers, and at least five years of practice. Strong skills in Excel, Epic, and WebEx, with knowledge of MCG/Interqual, are preferred.

Qualifications

• MD/DO degree required and board-certified in the physician's specialty.
• Must hold a valid New York State medical license along with a DEA and Medicaid number.
• Five years of medical practice experience required; willingness to work clinically in the primary specialty.
• Experience in utilization management, quality improvement, and case management operations beneficial.
• Familiarity with MCG and Interqual criteria and strong computer skills are expected.

Responsibilities

• Serve as the primary physician liaison for hospital utilization and resource use.
• Address provider practice patterns, over- and under-utilization, and medical necessity decisions.
• Oversee levels of care, care progression, length of stay management, and denial management.
• Ensure compliance with governmental and private payer regulations and coding requirements.

Skills

Utilization management

Quality improvement

Clinical leadership

Microsoft Excel

Epic

Cisco WebEx

Education

MD or DO degree

Board-Certified in specialty

Tools

Microsoft Excel

Epic

Cisco WebEx

Job description

Mount Sinai Hospital is seeking a full-time Physician Advisor to support hospital utilization, including provider practice patterns, resource use, and medical necessity decisions.

The role requires an MD or DO, board certification, NY license, DEA and Medicaid numbers, and at least five years of practice. Strong skills in Excel, Epic, and WebEx, with knowledge of MCG/Interqual, are preferred.