Physician Advisor

St. Joseph's Health • Paterson, NJ

47d • Onsite

About The Position

St. Joseph's Health is seeking a highly motivated Physician Advisor to partner with physicians, Care Management, and hospital leadership to ensure appropriate utilization of healthcare resources, regulatory compliance, and optimal patient outcomes. The Physician Advisor serves as a clinical resource for medical necessity reviews, patient status determinations, denials prevention and appeals, physician education, and length-of-stay management. This role plays a key part in improving patient flow, supporting quality initiatives, and ensuring compliance with CMS and payer requirements.

Requirements

• Graduate of an accredited medical school.
• Active New Jersey physician license.
• Minimum five (5) years of clinical practice experience.
• Strong communication, leadership, and collaborative skills.

Nice To Haves

• Experience with utilization management, denials, medical necessity reviews, or quality improvement preferred.
• Candidates who may not possess every preferred qualification but demonstrate the aptitude and commitment to develop these competencies are encouraged to apply.

Responsibilities

• Conduct medical necessity and utilization reviews.
• Provide guidance on patient status determinations and documentation requirements.
• Support denials management, appeals, and payer communications.
• Participate in observation, throughput, and length-of-stay meetings.
• Educate providers on utilization management, regulatory requirements, and best practices.
• Collaborate with Care Management, Social Work, and hospital leadership to improve patient outcomes and operational efficiency.

What This Job Offers

• Job Type: Part-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree