Physician Advisor (30688)

Physician Affiliate Group of New York • Brooklyn, NY

7d • Onsite

About The Position

Physician Affiliate Group of New York (PAGNY) is seeking a full-time Physician Advisor for Clinical Utilization at NYC Health + Hospitals/Kings County. This role involves collaborating with various departments to improve clinical utilization, reduce denial risks, and ensure adherence to regulatory requirements and payer guidelines. The Physician Advisor will also play a role in performance improvement projects and contribute to the development of utilization management policies. The hospital is a Level I Trauma Center with a strong academic affiliation, committed to providing high-quality healthcare services to all New Yorkers with compassion, dignity, and respect, regardless of their ability to pay.

Requirements

• Board Eligible or Board Certified in Internal Medicine
• Licensed to practice in the State of New York
• 1-2 years of prior Physician Advisor experience

Responsibilities

• Identify denial trends, perform root cause analysis, and implement targeted prevention strategies, including physician education on documentation best practices and alignment with ICD-10 coding and medical necessity criteria.
• Collaborate with ED to address front-end drivers of denial risk by reducing avoidable admission and observation cases and improving level-of-care documentation at the point of entry.
• Familiarize physicians, as well as case managers, with MCG and inter-Qual criteria for both admissions and documentation.
• Participate in performance improvement projects at Kings County, as well as other programs for the system.
• Review medical records and clinical documentation to support utilization management processes, identifying opportunities for alignment with regulatory requirements, payer guidelines, and organizational standards.
• Escalate clinical questions to licensed clinicians as appropriate, and participate in organizing the Utilization Review Committee.
• Work closely with physicians, nurses, case managers, administrators, and other stakeholders to foster effective communication, alignment, and consistency across utilization management and care coordination workflows.
• Contribute to the development, review, and refinement of utilization management policies, protocols, and workflows, ensuring alignment with regulatory standards and organizational goals.

Benefits

• 401(k) Company Contribution (3% immediate vesting, additional 7% after one year)
• Annual Continuing Medical Education (CME) Reimbursement
• Generous Annual Paid Time Off (PTO): Vacation, Sick, Holiday, and CME days
• Medical, Prescription, and Dental Coverage
• Life Insurance and Accidental Death and Dismemberment (AD&D) Coverage (2x salary up to $300,000)
• Voluntary Life and AD&D coverage
• Loan Forgiveness eligibility
• Medical Malpractice Coverage
• Healthcare and Dependent Care Flexible Spending Accounts (FSAs)
• Pre-tax employee-paid contributions for commuting expenses
• Visa sponsorship

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level