Physician Advisor

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

Scheduled Weekly Hours:

Position Overview

Pay Range:

$337,218.00 - $450,559.00

Capital Health Medical Group is seeking a Physician Advisor. This hybrid role is an essential part of the team, using medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials. Their work ensures patients receive appropriate, timely care. Serves as a key clinical leader and advisor to hospital leadership, medical staff, and utilization management teams. Provides expert guidance on appropriate utilization of medical services, regulatory compliance, clinical documentation integrity, and care management processes to ensure optimal patient outcomes and effective resource use. Acts as a liaison between clinical providers and administrative teams, offering education, consultation, and real-time decision support to improve patient flow, reduce denials, and advance quality and safety initiatives.

Opportunity Details:

• Serves as an expert on clinical criteria (Milliman / InterQual / other guidelines). Provides medical staff education related to Utilization Management criteria, documentation requirements, length of stay, and discharge readiness.
• Provides education to medical staff on topics relating to medical necessity, utilization management, compliance, and accurate and specific medical record documentation. Assists medical and professional staff with education regarding DRG LOS, denials, clinical documentation, practice guidelines within the EMR and any regulatory changes. Supports education to minimize clinical variability throughout the medical staff.
• Provides physician consultation on patient status determinations, including admission level of care, medical necessity, and regulatory compliance. Advises physicians regarding appropriate and necessary documentation.
• Serves as a resource for CDI and coding specialty when needed. to improve provider documentation quality, accuracy, and completeness. Collaborates with Clinical Documentation team to ensure timely documentation to support working DRG, in compliance with ICD-10 requirements. Reviews clinical documentation and provides feedback to medical staff to support appropriate coding, risk adjustment, and reimbursement. Follows up with physicians and professional staff to address documentation deficiencies and to update on procedural and terminology changes.
• Drives performance improvement by sharing physician specific data regarding LOS, readmissions, and case denials with the ED and Hospitalist Groups.
• Serves as resource/liaison, and provides guidance to other physicians regarding admission status, appropriate utilization of hospital resources, transition of patients with barriers to discharge. Assists to resolve avoidable delays, managing, length of stay, and optimizing discharge planning processes. Supports real-time decision making to ensure appropriate resource utilization and efficient patient throughput.
• Provides leadership of utilization management functions and serves as an active member/leader of the Utilization Review Committee.
• Serves as a liaison and communicates regulatory updates, documentation expectations, and utilization guidelines to physicians and APPs.
• Works collaboratively with the inter-professional team within Capital Health and outside agencies to achieve desired outcomes.
• Concurrently reviews cases to achieve timely and effective care across the continuum; ensures quality and effective patient care is provided.
• Participates in case reviews regarding levels of care, length of stay, resource utilization and avoidable delays
• Ensures compliance with CMS and provides second level review for Utilization Review by providing guidance on admission status and ongoing care utilizing guidelines, medical decision making and best practice. Ensures compliance with CMS conditions of participation and managed care contracts. Participates in Medicare audit reviews and the appeals process

Qualifications:

• MD or DO with unrestricted NJ medical license required
• MD or DO License in healthcare specialty, preferred
• Five years of direct clinical practice required, hospital-based experience preferred, Previous experience as physician advisor preferred, strong knowledge of case management, utilization review, regulatory standards, denials management, observation medicine, and length of stay, Familiarity with MCG and InterQual clinical criteria
• Additional certification in healthcare administration, business, or physician advisory, preferred
• ACPA-C or ABQUARP certification in Physician Advisory or willingness to obtain within one year of hire date
• MBA preferred

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Continuing Medical Education (CME)

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.