Physician Advisor

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Perform physician-to-physician evaluations regarding medical necessity, levels of care, and strategies for denial prevention and appeals.

• Assist utilization review and case management teams in navigating complex clinical decision-making scenarios.

• Ensure accurate admissions determinations (inpatient vs. observation) in accordance with CMS and payer guidelines.

• Provide clinical leadership concerning length of stay, care progression, and planning for discharge.

• Guarantee compliance with CMS Conditions of Participation, Medicare regulations, and payer policies.

• Facilitate adherence to medical necessity standards (InterQual, MCG, or comparable criteria).

• Aid in audit readiness and responses, including those for RAC, MAC, and commercial payer audits.

• Collaborate with HIM/CDI teams to enhance documentation quality and clinical accuracy.

• Act as a reliable peer resource for attending physicians and advanced practice providers.

• Educate medical personnel on regulatory obligations, best practices for utilization, and documentation standards.

• Support change management initiatives within clinical operations and compliance frameworks.

⛳️ Requirements

• Must possess an MD or DO with an active, unrestricted medical license.

• Board-certified or board-eligible in a recognized medical specialty.

• Clinical practice experience in an acute care or related healthcare environment is essential.

• Strong understanding of utilization management, medical necessity, and payer regulations.

• Exceptional communication skills with the capability to engage in peer-to-peer discussions.

• Previous experience as a Physician Advisor, Medical Director, or in Utilization Review is preferred.

• Familiarity with CMS guidelines, InterQual, MCG, and denial management processes is advantageous.

• Experience collaborating with case management, CDI, HIM, or revenue cycle teams is preferred.

• Background in a remote or consulting healthcare environment is a plus.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and continuing education.

• Flexible work environment with remote options available.

• Supportive team culture focused on collaboration and innovation.