Physician Advisor

All the benefits and perks you need for you and your family:Benefits from Day OnePaid Days Off from Day OneCareer DevelopmentWhole Person Wellbeing ResourcesMental Health Resources and Support Our promise to you: Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.Schedule: Full TimeShift: DaysLocation: 601 East Rollins Street Orlando, FL 32803The community youll be caring for: AdventHealth Orlando Located on a lush tropical campus, our flagship hospital, 1,368-bed AdventHealth Orlando Serves as the major tertiary facility for much of the Southeast, the Caribbean and South America AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year The role youll contribute: As the physician advisor (PA), this role educates, informs, and advises members of the Utilization Management, Health Information Management (HIM), Revenue Cycle, Patient Financial Services, Patient Access, AHS Managed Care departments and applicable medical staff of specific updates, statistical trending and/or changes related to denial prevention measures for our contracted managed care payers. The PA role is responsible for providing physician review of utilization, claims management, and quality assurance related to inpatient care, outpatient care/observation stays and referral services. This position supports and interfaces with the CMO capacities at all facilities within the Central Florida Division South Region by ensuring the delivery of high-quality, efficient healthcare services throughout the continuum of care for the membership served by contracted medical group provider networks. The PA is an important contact for clinicians, external providers, contracted health insurance payers, and regulatory agencies. It also serves as subject matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient focused and cost-effective medical care. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

SCOPE OF RESPONSIBILITY:

Responsible for reviewing and authorizing inpatient days and the evaluation of inpatient utilization patterns within service areas to identify areas of improvement, developing specific strategies and criteria addressing areas of need. Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive and supportive relationship between the inpatient facilities, health plans and physicians (hospitalist groups and primary care providers). Works in close coordination with the processes of the Utilization Review Management staff for continual process improvement and reporting. Reviews and makes recommendations on appealed provider claims. Provides support, shares administrative call, and maintains collaborative relations with the other medical directors. Advise and educate Utilization Management staff regarding clinical issues. Acts as liaison for and with attending physicians to arrive at most appropriate inpatient/outpatient utilization determinations. Assists in other duties related to utilization review and quality improvement of the network as assigned by the Division CFO/Sr VP, Vice President of Revenue Cycle Operations and/or Executive Director Middle Revenue Cycle/Utilization Management. Reviews data and trends to identify opportunities for utilization improvement to positively influence practice patterns. Conducts regular, ongoing meetings with Utilization Management to ensure continuity and efficiency in the inpatient setting. Develops utilization benchmarking for specialty groups within the Orlando market. Manages specialty-specific quality screens and utilization outliers. Acts as a liaison between contracted Managed Care/Commercial payers related to managed care denials, Utilization Management and the Hospitals Medical Staff to facilitate the accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, in addition to DRG assignment. Establishes and maintains a presence within the Medical Staff structure and active participation on applicable committees (i.e. JOC/Payer, Revenue Cycle, Finance Committee, etc.).

COMPLIANCE/REGULATORY RESPONSIBILITY:

Educates, consults, and advises members of the Medical Staff on regulatory updates and changes related to Care Management and/or Utilization Management. Serves as an active participating member of the Utilization Management (UM) Committee by ensuring committee is actively reviewing and acting upon trends identified through data. Provides trend data of denials to assist in improving payer or care delivery behavior. OPERATING & CAPITAL BUDGET/FINANCIAL RESPONSIBILITY: Aid in supporting Length of Stay (LOS) strategies (avoidable days) and quality goals. Reviews concurrent payer denials and intervenes with attending and/or consulting physicians and managed care medical directors, as needed, for reconsideration and denial avoidance.

STRATEGIC PLANNING RESPONSIBILITY:

Provides input on developing plans for physician education to meet identified needs and provides information to members of the Medical Staff and clinical departments on Utilization Management guidelines and protocols. Qualifications Graduate from medical school and residency program (Required) 5 Recent clinical practice (Required) MD – Physician – State Licensure FL (Required) Board certified and eligible for membership on the hospital medical staff (Required) This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location. AdventHealth #J-18808-Ljbffr AdventHealth