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
- Enhancing provider education
- Supporting appropriate utilization of hospital services
The ideal candidate will bring:
- A collaborative spirit
- Excellent communication skills
- A strong foundation in clinical practice, documentation integrity, and regulatory compliance
Key Responsibilities
Physician & Clinical Staff Education
- 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
Utilization Management & Review
- 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
Collaboration & Communication
- 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
