Physician Advisor: Utilization & Denial Management

PAGNY; New York (NY); On-site; USD 241,000 - 246,000; Full time

Benefits offered by this job

401(k) company contributions

CME reimbursement

Paid time off

Health and dental coverage

Job summary

PAGNY, in collaboration with NYC Health + Hospitals/Kings County, seeks a Physician Advisor for Clinical utilization in Brooklyn. The role supports denial management, utilization review, and education across clinical teams to align with payer requirements and regulatory standards.

The position emphasizes collaboration with ED, case managers, and physicians, with a strong focus on documentation improvement and quality metrics within a large municipal health system.

Qualifications

• Board-certified or board-eligible in Internal Medicine.
• Licensed to practice in New York.
• 1–2 years of physician advisor experience.

Responsibilities

• Support the denial management and appeal process with clinical analysis and documentation review to strengthen submissions.
• Identify denial trends, perform root-cause analysis, and implement prevention strategies including physician education on documentation and ICD-10 alignment.
• Collaborate with Emergency Department to reduce denial risk by improving level-of-care documentation at entry.
• Develop and deliver education on utilization management principles, regulatory expectations, and payer requirements in collaboration with Compliance and Revenue Cycle leadership.
• Review medical records to support utilization management processes and escalate clinical questions to licensed clinicians as appropriate.

Skills

Clinical analysis

Denial management

Communication with payors

Utilization management

Education

Board Eligible or Board Certified in Internal Medicine

Tools

ICD-10 coding

Job description

PAGNY, in collaboration with NYC Health + Hospitals/Kings County, seeks a Physician Advisor for Clinical utilization in Brooklyn. The role supports denial management, utilization review, and education across clinical teams to align with payer requirements and regulatory standards.

The position emphasizes collaboration with ED, case managers, and physicians, with a strong focus on documentation improvement and quality metrics within a large municipal health system.