Physician Advisor ($300,000/yr) - 244699

Overview

We are seeking an experienced and dynamic Physician Advisor to serve as a critical liaison between clinical teams , health information management , and care management departments .

This position plays a key role in:

• Improving clinical documentation
• Supporting appropriate utilization of hospital services

The ideal candidate will bring:

• A strong foundation in clinical practice , documentation integrity , and regulatory compliance

Key Responsibilities

• Educate physicians on the relationship between clinical language , ICD-10 coding , DRG assignment , and the impact on severity of illness (SOI) , risk of mortality (ROM) , and performance metrics
• Conduct one-on-one and departmental educational sessions with medical staff (Internal Medicine, Surgery, Orthopedics, etc.) to improve clinical documentation and understanding of coding guidelines
• Share data, trends, and practice patterns to guide documentation improvements
• Provide education on medical necessity , appropriate utilization of hospital services, and regulatory compliance

Clinical Documentation Integrity (CDI) Program Support

• Collaborate with CDI and Coding teams to develop, optimize, and implement a sustainable and integrated CDI program
• Act as a trusted advisor in aligning clinical documentation with coding standards and quality metrics
• Identify potential pitfalls in CDI implementation and offer proactive solutions to gain provider buy-in
• Perform concurrent and retrospective medical record reviews , evaluating documentation against medical necessity standards
• Support case managers and care teams by reviewing admissions , continued stays , and issuing non-coverage notices when appropriate
• Participate in interdisciplinary rounds and guide level of care determinations
• Assist in denial management , including appeals and peer-to-peer discussions with payers
• Serve as a liaison between clinical departments , case management , utilization review , and health information management
• Provide actionable insights and education to improve continuity of care and reduce readmission rates
• Support care teams in identifying community resources and alternative levels of care when appropriate

Must-Have Qualifications

• Graduate of an accredited medical school with an active New Jersey medical license
• Minimum of 5 years of clinical practice experience
• Familiarity with clinical documentation improvement (CDI) , ICD-10 , DRG , and reimbursement methodologies
• Strong working knowledge of utilization management processes and criteria such as MCG or InterQual
• Strong analytical, organizational, and communication skills

Preferred Qualifications

• Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)
• Previous experience participating in CDI and/or utilization review initiatives
• Experience in peer-to-peer reviews or working directly with insurance payers
• Knowledge of hospital operations , administrative standards , and case management workflows

Soft Skills & Attributes

• Excellent verbal, written, and interpersonal communication skills
• Proven ability to build rapport with physicians and leadership to drive collaboration
• Strong presentation and teaching abilities
• Demonstrated flexibility and ability to adapt in a dynamic healthcare environment
• Effective multitasking , priority setting , and problem-solving abilities
• Results-driven with a focus on achieving outcomes