Physician Advisor (30688)

Physician Affiliate Group of New York•New York, NY

8d•$241,000 - $246,000•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 identifying denial trends, performing root cause analysis, and implementing prevention strategies, including physician education on documentation and coding. The Physician Advisor will collaborate with the ED to reduce avoidable admissions and improve level-of-care documentation. They will also educate physicians and case managers on MCG and inter-Qual criteria, participate in performance improvement projects, review medical records to support utilization management, and escalate clinical questions as needed. The position involves organizing the Utilization Review Committee and working closely with various stakeholders to ensure effective communication and consistency in utilization management and care coordination. The Physician Advisor will also contribute to the development and refinement of utilization management policies and protocols.

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.
Provide 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 and case managers with MCG and inter-Qual criteria for admissions and documentation.
Participate in performance improvement projects at Kings County and 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.
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.