Remote Physician Advisor — Utilization & Clinical Guidance

HURC; Short Hills (NJ); On-site; USD 180,000 - 260,000; Full time

Job summary

HURC seeks a Physician Advisor to lead physician-to-physician reviews and provide clinical guidance across care settings. The role emphasizes evidence-based utilization management and appropriate resource use.

You will collaborate with care teams on medical necessity, CMS rules, and payer guidelines, oversee admission status decisions, and contribute to documentation quality with HIM/CDI partners. A strong background in acute care and peer communication is essential.

Qualifications

• MD or DO with active, unrestricted license.
• Board-certified or board-eligible in a recognized specialty.
• Clinical practice experience in an acute care or relevant healthcare setting.
• Strong knowledge of utilization management, medical necessity, and payer regulations.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct physician-to-physician reviews for medical necessity and level of care.
• Support utilization review, case management, and clinical decision-making.
• Ensure admission status determinations (inpatient vs. observation) align with CMS and payer guidelines.
• Provide clinical oversight on length of stay, care progression, and discharge planning.
• Assist with audits (RAC, MAC, and commercial payer) and documentation processes.
• Partner with HIM/CDI teams to improve documentation quality and clinical accuracy.

Skills

MD/DO license

Board-certified/eligible

Acute care experience

Regulatory knowledge

Communication skills

Education

Medical Doctor (MD)

Job description

HURC seeks a Physician Advisor to lead physician-to-physician reviews and provide clinical guidance across care settings. The role emphasizes evidence-based utilization management and appropriate resource use.

You will collaborate with care teams on medical necessity, CMS rules, and payer guidelines, oversee admission status decisions, and contribute to documentation quality with HIM/CDI partners. A strong background in acute care and peer communication is essential.