Physician Advisor, Per Diem

Job Description St. Joseph’s Health | New Jersey Per Diem | Maximum 6 Hours per Week Make an Impact Beyond the Bedside St. Joseph’s Health is seeking an experienced, collaborative Physician Advisor to join our Utilization Management team in a flexible per-diem capacity. This is an excellent opportunity for a practicing or experienced physician interested in using their clinical expertise to influence patient status determination, medical necessity, utilization management, denials prevention, clinical documentation, and hospital throughput—while working closely with physicians, Care Management, Social Work, hospital leadership, and payer partners. With a commitment of up to 6 hours per week, this role is ideal for a physician looking to expand into Physician Advisor or Utilization Management work while maintaining other clinical or professional responsibilities. Responsibilities As a Physician Advisor, you will serve as a clinical resource and trusted partner to physicians and hospital teams, helping ensure patients receive the right level of care at the right time while supporting regulatory compliance and appropriate resource utilization. Key Responsibilities Include Conduct second-level medical necessity and utilization reviewsReview observation cases and apply the CMS Two-Midnight Rule when appropriatePerform admission, continued stay, Medicare short-stay, readmission, and pre-/post-bill reviewsParticipate in observation and escalation huddles to support appropriate patient status and timely dispositionPartner with physicians on medical necessity and clinical documentationPerform and support medical necessity appeals and denials management across payersCollaborate with Care Management, Social Work, Utilization Review, and hospital leadershipCommunicate with third-party payers when necessary to facilitate approvals and prevent avoidable denialsHelp identify barriers affecting length of stay, discharge, and hospital throughputEducate and coach physicians regarding utilization management, documentation, medical necessity, and patient statusSupport organizational quality improvement and utilization management initiativesParticipate in Utilization Management and other hospital committees as appropriateMaintain and expand knowledge of CMS regulations, payer requirements, Joint Commission standards, and New Jersey healthcare regulations Qualifications MD or DO from an accredited medical schoolCurrent or eligible New Jersey physician licenseMinimum of 5 years of recent clinical practice experienceStrong clinical judgment and communication skills Preferred Experience Previous Physician Advisor or utilization management experienceParticipation on a Utilization Management/Utilization Review committeeKnowledge of CMS regulations and the Two-Midnight RuleExperience with medical necessity criteria, patient status determination, denials, and appealsUnderstanding of commercial payer requirementsFamiliarity with clinical documentation and documentation improvementExperience with length-of-stay and throughput initiativesPhysician education, coaching, or leadership experience