Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

Duties and Responsibilities:

Inpatient Clinical Optimization: Care Coordination, Progression, and Variation

• Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advice, and quality issues.
• Maintains knowledge of government regulations related to utilization review, transition planning, billing, and managing patients and acts as a resource to physicians and staff related to these regulations.
• Perform second level reviews, peer-to-peer calls and advise on continued stay reviews that require additional Physician Advisor input.
• Knowledge of appeals process and necessary documentation improvement.
• Interacts with medical staff by seeking additional clinical information from physicians, discussing patients’ needs, suggesting alternative treatment options, and recommending next steps.
• Functions as a consultant and resource to primary (attending) physicians.
• Reinforces evidenced-based medicine best practices and adherence to reduction in clinical variation.
• Supports care team, patient placement department and nursing supervisors by assisting with patient placement decisions (as needed), care/discharge delays, and patient throughput.
• Provides support to ancillary services departments (e.g., lab and radiology) by mitigating the inappropriate or unnecessary use of services.
• Participates in daily Escalation Huddles to support care team communication and coordination activities, and to discuss selected cases (e.g., outliers or care/discharge barriers) and makes recommendations regarding care.
• Prepares for and participates in (or ideally, leads) monthly Utilization Management (UM) Committee.
• Documents patient care reviews, determinations, and other pertinent information per hospital/care coordination policies.
• Maintains a consistent professional presence at facility campus to support medical staff and perform daily responsibilities.

Clinical Documentation Improvement

• Provides expertise to CDI specialists, enhancing query processes and physician engagement to ensure medical documentation accurately reflect patient care complexity.
• Designs and conducts educational programs for medical and CDI staff, updating training to include the latest clinical guidelines and coding standards.
• Reviews and advises on medical records to ensure documentation quality, addressing gaps and aligning with regulatory and billing standards.
• Develops strategic CDI initiatives aligned with healthcare quality goals and provides clinical expertise on complex cases and documentation standards.

Minimum Qualifications

• Education: Graduate of an accredited medical school. Additional education in quality and utilization management through continuing medical education programs and self-study preferred.
• Experience: Minimum of five years recent experience in clinical practice. Utilization management experience as a member of the UM oversight committee or past Physician Advisor experience preferred.
• Ability to travel to the various Catholic Health locations.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.