Job Description

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 & 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

Responsibilities

• 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.

Qualifications

• 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.

Benefits Eligibility: (Full-time and Part-time Employees-over 20 hours a week)

• Competitive salary*
• Robust benefits with health, dental, Rx and vision plans
• 403b retirement plan options with company match**
• Health & Wellness*
• Non-Profit Health System - eligible for Federal Student Loan Forgiveness
• PTO, and paid holidays
• Tuition reimbursement
• Employee Assistance Program
• LTD : Long Term Disability
• Life Insurance Options
• Onsite Day care Program

*Available for Per Diem Employees and Part-time Employees working under 20 hours per week.

**403b Company Match not applicable for Per Diem Employees and Part-time Employees working under 20 hours per week.

Pay transparency: St. Joseph's Health provides a salary range to comply with New Jersey Law. The rate of pay for each position will be determined based on a variety of factors including the candidate's relevant experience, qualifications, skills, etc." The salary range does not include incentives, differential pay or other forms of compensation.

About the Team

St. Joseph's University Medical Center is an academic tertiary care medical center and state designated trauma center, located on the Paterson campus, regularly accepts referrals of difficult or unusual cases from other hospitals and physicians and performs both complex and routine procedures.

The Medical Center offers a full complement of specialty and subspecialty services including ambulatory, behavioral health, cardiovascular, emergency/trauma, internal medicine, neuroscience, oncology, orthopedic/spine, rehabilitation, surgical specialty, women's health, imaging and pediatrics.

The nursing team at St. Joseph's University Medical Center, which includes St. Joseph's Children's Hospital, has held the Magnet Award for Nursing Excellence, the profession's highest honor, since 1999. They are also recipients of the prestigious 2010 Magnet Prize™ - one of only 8 Magnet-designated hospitals to ever receive The Magnet Prize, and the only one worldwide to receive the 2010 award.