hurc
Physician Advisor
SHORT HILLS, New Jersey, United States
Sponsorship not specifiedDetected 20 days ago
NegotiationCommunicationCollaboration
About the role
- The Physician Advisor provides physician-to-physician reviews, clinical guidance, education, and escalation support while promoting evidence-based practices and appropriate resource utilization.
- Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals
Responsibilities
- Support utilization review and case management teams with complex clinical decision-making
- Partner with HIM/CDI teams to improve documentation quality and clinical accuracy
- Support change management initiatives related to clinical operations and compliance
Requirements
- Ability to influence without authority
Nice to have
- Ensure appropriate admission status determinations (inpatient vs. observation) in alignment with CMS and payer guidelines
- Provide clinical oversight related to length of stay, care progression, and discharge planning
- Ensure adherence to CMS Conditions of Participation, Medicare regulations, and payer policies
- Assist with audit preparedness and response, including RAC, MAC, and commercial payer audits
- Serve as a trusted peer resource to attending physicians and advanced practice providers
- Board-certified or board-eligible in a recognized specialty
- Excellent communication skills with the ability to conduct peer-to-peer discussions
- Familiarity with CMS guidelines, InterQual, MCG, and denial management processes
Benefits
- Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals
- Support compliance with medical necessity criteria (InterQual, MCG, or equivalent)
- Education & Physician Engagement
- Educate medical staff on regulatory requirements, utilization best practices, and documentation standards
This listing is sourced directly from hurc's careers page and normalized into a canonical job model.