Physician Advisor

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

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HURC Healthcare Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2018

🤝 B2B

⚕️ Healthcare Insurance

🎯 Recruiter

B2B • Healthcare Insurance • Recruitment

HURC Healthcare Solutions is a B2B healthcare services firm that partners with hospitals and provider organizations to manage utilization review, clinical revenue cycle operations, and population health outreach. The company provides centralized Utilization Review (CŪR), revenue cycle management that combines domestic oversight with offshore resources, and staff augmentation and automation services to maximize net patient revenue and reduce operational burdens. HURC emphasizes people-powered, customizable services that integrate with clients' existing systems and bridge the payer-provider gap so clinicians can focus on patient care.

📋 Description

• Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals • Support utilization review and case management teams with complex clinical decision-making • Ensure appropriate admission status determinations (inpatient vs. observation) in alignment with CMS and payer guidelines • Provide clinical oversight related to length of stay, care progression, and discharge planning • Ensure adherence to CMS Conditions of Participation, Medicare regulations, and payer policies • Support compliance with medical necessity criteria (InterQual, MCG, or equivalent) • Assist with audit preparedness and response, including RAC, MAC, and commercial payer audits • Partner with HIM/CDI teams to improve documentation quality and clinical accuracy • Serve as a trusted peer resource to attending physicians and advanced practice providers • Educate medical staff on regulatory requirements, utilization best practices, and documentation standards • Support change management initiatives related to clinical operations and compliance

🎯 Requirements

• Required MD or DO with an active, unrestricted medical license • Board-certified or board-eligible in a recognized specialty • Clinical practice experience in an acute care or relevant healthcare setting • Strong knowledge of utilization management, medical necessity, and payer regulations • Excellent communication skills with the ability to conduct peer-to-peer discussions • Prior experience as a Physician Advisor, Medical Director, or in Utilization Review preferred • Familiarity with CMS guidelines, InterQual, MCG, and denial management processes preferred • Experience working with case management, CDI, HIM, or revenue cycle teams preferred • Experience in a remote or consulting healthcare environment preferred.