Physician Advisor (30688)

Physician Affiliate Group of New York (PAGNY) is adding a Physician Advisor to the group at NYC Health + Hospitals/Kings County. Kings County Hospital operates a world-renowned Level I Trauma Center, one of only three in Brooklyn, which serves 2.6 million residents of Brooklyn and Staten Island. The hospital maintains a strong academic affiliation with SUNY Downstate Health Sciences University to maintain its high healthcare delivery standards.

The Mission of NYC Health + Hospitals is to extend equally to all New Yorkers, regardless of the ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity, and respect. Their Values are built on a foundation of social and racial equity and have established the ICARE standards for all staff.

NYC Health + Hospitals is the nation’s largest municipal healthcare delivery system in the United States. Dedicated to providing the highest quality health care services to all New Yorkers with compassion, dignity and respect, regardless of immigration status or ability to pay.

Opportunity Details:

The Department of Medicine at Kings County is seeking a full-time Physician Advisor for Clinical utilization.

• 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.