Capital Health
Lawrenceville, New Jersey, United States
Spotlight Preferred
6 days ago


Capital Health is searching for data-driven, collaborative, and innovative Physician Advisors who will also serve on the Physician Advisor team at Capital Health. The Physician Advisor will partner with other physicians, utilization review nurses, care managers and members of the inter-professional team to ensure that care is being delivered in the appropriate setting, at the appropriate level or care, at the appropriate time and offer facilitation/resolution to issues related to the appropriate utilization of health system resources. The Physician Advisor will work at the individual case level, the aggregate level and will be facile with the EHR. They will contribute to the development of optimal hospital flow, safe transitions of care and the overall mission of Capital Health. In order to manage utilization effectively, the PAs will fully understand the complexities of billing and coding and also assist in resolution of charity care and clinical overrides requests. These positions directly report up through the CMO of Inpatient Care.

The Physician advisor will promote alignment and collaboration with physicians regarding culture, satisfaction, engagement and problem solving

They will Acts as a liaison to Utilization review, the CMO, professional staff and hospital administration for questions or concerns. They will advocate for patient/family-centered care and health equity. They will also partner with medical and professional staff to promote organizational stewardship of healthcare resources.


* Serve as an expert on clinical criteria (Milliman / InterQual / other guidelines)

* Provide 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

* Advises physicians regarding patient status and appropriate and necessary documentation

* Serves as a resource for CDI and coding specialty when needed

* Collaborates with Clinical Documentation team to ensure timely documentation to support working DRG, in compliance with ICD-10 requirements

* 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

* Act as a liaison to medical staff

* Serve as resource, liaison, and provides guidance to other physicians regarding admission status, appropriate utilization of hospital resources, transition of patients with barriers to discharge

* Provide leadership of utilization management functions and serve as active member/leader of the Utilization Review Committee

* Supports throughput and efficient patient flow

* Perform chart audits

* Concurrently reviews cases to achieve timely and effective care across the continuum; ensures quality and effective patient care is provided

* Provide coaching and education to physicians regarding clinical documentation

* Work collaboratively with the inter-professional team within Capital Health and outside agencies to achieve desired outcomes

* Participates in case reviews regarding levels of care, length of stay, resource utilization and avoidable delays

* Applies clinical knowledge for appropriate length of stay

* Supports care management in progressing care to meet length of stay goals

* Promotes and supports patient safety initiatives

* In compliance with CMS, provide 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


• Must be a NJ licensed M.D./D.O.

• A minimum of five (3) years in medical practice, exclusive of post-graduate training

• Board Certification in primary clinical specialty

• Active ACLS and BLS


      Previous experience as a Physician Advisor

      American College of Physician Advisors ACPA Certification 

Job ID: 72249763

Please refer to the company's website or job descriptions to learn more about them.

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