Physician Advisor

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.

The Physician Advisor works primarily Tuesday 12pm-5pm Thursday 1:30pm-6:30pm

Occasional calls off-hours if major, time-sensitive issues should arise

May work other hours to assure UM program elements are in place and functioning off-hours

• 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.

• Graduate of an accredited medical school.
• Active New Jersey physician license.
• Minimum five (5) years of clinical practice experience.
• Experience with utilization management, denials, medical necessity reviews, or quality improvement preferred.
• Strong communication, leadership, and collaborative skills.

Candidates who may not possess every preferred qualification but demonstrate the aptitude and commitment to develop these competencies are encouraged to apply.