Physician Advisor — Utilization & Denial Prevention Leader

New York City Health and Hospitals Corporation; New York, Northern (NY, KY); Hybrid; USD 241,000 - 246,000; Full time

Benefits offered by this job

401(k) company contribution

CME reimbursement

Paid time off

Health, dental, prescription coverage

Life insurance & AD&D

Loan forgiveness programs

Malpractice coverage

FSAs

Job summary

NYC Health + Hospitals Kings County seeks a full-time Physician Advisor for Clinical utilization to identify denial trends, analyze root causes, and guide documentation improvements. The role collaborates with ED to reduce unnecessary admissions and enhance entry-level care documentation.

You will work with physicians, nurses, case managers, and administrators to align utilization management with regulatory standards, payer guidelines, and organizational goals.

Qualifications

• Board Eligible or Board Certified in Internal Medicine.
• Licensed to practice in the State of New York.
• 1–2 years of prior Physician Advisor experience.

Responsibilities

• Identify denial trends, perform root cause analysis, and implement targeted prevention strategies; educate physicians on documentation and ICD-10 coding.
• Collaborate with the ED to reduce avoidable admission and observation cases; improve level-of-care documentation at entry.
• Familiarize physicians and case managers with MCG and inter-Qual criteria for admissions and documentation.
• Participate in performance improvement projects across Kings County and system programs.
• Review medical records to support utilization management; escalate clinical questions to licensed clinicians and participate in Utilization Review Committee.
• Work with physicians, nurses, case managers, admins, and others to align utilization management and care coordination workflows.
• Contribute to development and refinement of utilization management policies and workflows.

Education

Internal Medicine Board Eligible/Board Certified

Job description

NYC Health + Hospitals Kings County seeks a full-time Physician Advisor for Clinical utilization to identify denial trends, analyze root causes, and guide documentation improvements. The role collaborates with ED to reduce unnecessary admissions and enhance entry-level care documentation.

You will work with physicians, nurses, case managers, and administrators to align utilization management with regulatory standards, payer guidelines, and organizational goals.