Physician Advisor for Utilization Management with Jefferson Health New Jersey

Job Details

Job Description

Job Title:Physician Advisor Utilization Management
Location:Southern New Jersey
Job Type:Fulltime
Company:Jefferson Health New Jersey
Salary:Competitive with comprehensive benefits package

About Us:
Jefferson Health is a leading integrated healthcare delivery system in Eastern Pennsylvania and Southern New Jersey committed to providing quality care to our patients while maintaining efficient and effective resource utilization. We are seeking a dedicated and experiencedPhysician Advisorto join our Utilization Management (UM) team. This is an exciting opportunity for a seasoned physician to make an impactful difference in optimizing patient care and ensuring that services provided meet established medical necessity and quality standards.

Job Overview:
As a Physician Advisor in Utilization Management you will work closely with clinical and administrative teams to review evaluate and manage healthcare services to ensure appropriate utilization medical necessity and adherence to evidencebased guidelines. You will play a key role in improving patient outcomes while ensuring that care provided is both efficient and costeffective.

Key Responsibilities:

• Review patient cases for correct statusing medical necessity appropriateness of care and adherence to clinical guidelines and protocols.
• Collaborate with physicians case managers and other healthcare providers to ensure optimal patient care and resource utilization.
• Provide clinical guidance and expertise on utilization management decisions including authorizations denials and appeals.
• Work with the utilization management team to develop and implement best practices for care management and patient flow.
• Participate in case discussions interdisciplinary meetings multidisciplinary patient care rounds and policy development to enhance care coordination.
• Assist in reviewing medical records and documentation for accuracy and compliance with regulatory standards.
• Support quality improvement initiatives patient safety and overall operational efficiency.

Qualifications:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
• Board certification in a clinical specialty.
• Active and unrestricted medical license in NJ
• Minimum of 35 years of clinical experience in a hospital or healthcare setting.
• Prior experience in utilization management case management or quality assurance is highly preferred.
• Strong knowledge of medical necessity criteria clinical guidelines and healthcare regulations (e.g. CMS NCQA).
• Excellent communication skills and ability to work collaboratively with clinical and administrative teams.
• Analytical skills with the ability to interpret medical data and make evidencebased decisions.

Benefits:

• Competitive salary and performancebased bonuses.
• Comprehensive health dental and vision insurance.
• Generous paid time off (PTO) and holidays.
• Retirement plan with employer matching.
• Continuing medical education (CME) allowance and support for professional development.
• Worklife balance with flexible scheduling options.
• Opportunity to work with a dynamic and dedicated team in a growing healthcare organization.

Please apply and send CV to David May @

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Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highestquality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21stcentury careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 notforprofit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a notforprofit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.