Physician Utilization & Quality Advisor

Tal Healthcare; New York (NY); On-site; USD 190,000 - 270,000; Full time

Benefits offered by this job

4 weeks PTO

30 days sick leave

13 paid holidays

CME leave with $2,000 allowance

403(b) employer contribution 10% after

457(b) savings option

Inclusive workplace

Professional growth opportunities

Job summary

Tal Healthcare's client, a leading academic medical center affiliated with a prominent university, seeks a Physician Advisor. The role balances clinical practice with administrative oversight to optimize hospital utilization, resource management, and financial sustainability while maintaining high-quality patient outcomes.

You will collaborate with multidisciplinary teams, develop protocols, monitor utilization data, lead denial management, and participate in quality improvement projects, while

Qualifications

• MD or DO degree with Board Certification.
• New York State medical license, DEA, and Medicaid number.
• Minimum five years of medical practice experience with utilization management and quality improvement.
• Knowledge of medical necessity criteria such as InterQual and MCG.
• Strong interpersonal and communication skills across departments.
• Proficiency in Excel, Epic, and Cisco WebEx.

Responsibilities

• Act as liaison between medical staff, case management, and finance to identify optimization opportunities.
• Develop and implement protocols, training programs to improve levels of care and documentation.
• Monitor provider practice patterns and utilization data to reduce over- and under-utilization.
• Collaborate with leadership to ensure adherence to medical necessity criteria and regulatory guidelines.
• Lead denial management efforts and contribute to coding accuracy.
• Participate in quality improvement projects and utilization review processes.
• Maintain clinical practice in the primary specialty while contributing to operations.

Skills

Utilization management

Quality improvement

Communication

Regulatory compliance

Education

MD or DO degree

Board Certification in specialty

Tools

Epic

Microsoft Excel

Cisco WebEx

Job description

Tal Healthcare's client, a leading academic medical center affiliated with a prominent university, seeks a Physician Advisor. The role balances clinical practice with administrative oversight to optimize hospital utilization, resource management, and financial sustainability while maintaining high-quality patient outcomes.

You will collaborate with multidisciplinary teams, develop protocols, monitor utilization data, lead denial management, and participate in quality improvement projects, while