Physician Advisor (Clinical Assistant Professor, HS)

About the role

The Physician Advisor plays a critical role in optimizing healthcare delivery by providing guidance on medical necessity, utilization management, and quality improvement initiatives. They collaborate with healthcare teams to ensure compliance with regulatory standards and promote cost-effective care delivery. This is a full-time position reporting to the Chief Medical Officer. Candidates can inquire about part-time availability.

Responsibilities

• Review medical records and documentation to assess the appropriateness of services rendered and ensure compliance with regulatory guidelines (Utilization Review).
• Evaluate the medical necessity of procedures, treatments, and hospital admissions/level of care (Inpatient vs. observation) based on established criteria and guidelines.
• Collaborate with case managers, social workers, and healthcare providers to develop care plans that meet patients' clinical needs while optimizing resource utilization to improve Length of Stay.
• Lead the denial appeal process to optimize the resolution of insurance denials by providing clinical expertise and supporting appeals processes. Identify trends in denial cases, perform root cause analysis, and develop actionable plans to prevent future denials, including targeted physician education on documentation best practices and alignment with appropriate ICD-10 coding and medical necessity criteria.
• Provide education and training to healthcare professionals on utilization management principles, documentation requirements, and regulatory compliance.
• Collaborate with Clinical Documentation Improvement (CDI) teams to ensure appropriate physician documentation with a goal to improve utilization, Case Mix Index (CMI), and risk-adjusted quality measures.
• Work closely with physicians, nurses, administrators, and other stakeholders to promote effective communication and coordination of care.
• Contribute to the development and revision of utilization management policies, protocols, and procedures.
• Lead the Utilization Management Committee.
• Monitor and evaluate key performance indicators related to utilization management, quality of care, and financial outcomes.
• Perform clinical duties (up to 25% of the position).
• Perform other duties as assigned by the Chief Medical Officer.

Requirements

• Medical degree (MD or DO).
• Active medical license.
• Knowledge of utilization management principles, regulatory requirements, and healthcare economics.
• Strong analytical skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Preferred Qualifications

• Experience with electronic health records (EHR) and healthcare information systems.
• Clinical experience in a hospital or healthcare setting.

Pay

Total compensation of $275,000 - $325,000.

About Us

SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.