Physician Advisor, Miami, Florida, Full-Time

Baptist Health; Miami (FL); On-site; USD 210,000 - 320,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

CME opportunities

Retirement benefits

Baptist Health University

Job summary

Baptist Health South Florida is seeking a Physician Advisor to provide clinical leadership and ensure appropriate level of care, documentation, coding and medical necessity across the hospital system. The role collaborates with Case Management, admitting physicians and payer relations to optimize patient care and utilization.

The incumbent will review complex cases, ensure CMS compliance, and support denials management while guiding physicians on optimal care pathways and post-discharge

Qualifications

• MD or DO with active, unrestricted license.
• Physician Advisor certification (ABQAURP or equivalent) within 1 year of hire.
• Minimum 3 years as a practicing physician with case review experience.
• Knowledge of CMS Two-Midnight Rule, inpatient billing and utilization management.

Responsibilities

• Provide physician leadership on federal/state compliance, documentation, medical necessity and clinical validation.
• Collaborate with admitting physicians, Case Management, and healthcare team to manage cases from admission to discharge.
• Review cases with Denials and Appeals teams and communicate with payer medical directors to facilitate approvals.
• Advise physicians and Case Management on hospitalization, resource utilization and quality regulations.
• Identify transitions to appropriate care levels (SNF, palliative, long-term care) when appropriate.
• Promote continuity of care, reduce length of stay and avoidable readmissions.

Skills

MD/DO

Florida license

Physician Advisor cert

CMS/InterQual knowledge

Case review experience

Education

MD/DO degree

Job description

Baptist Health South Florida and Bethesda Health have merged to launch a new era of healthcare in Palm Beach County. Together, we are developing and sharing best practices that enhance the level of care we deliver to patients and families.

Bethesda Health is a comprehensive, community-based hospital system that has grown with our community. One of the few remaining not-for-profit health systems in Palm Beach County. Our flagship hospital, Bethesda Hospital East (formerly known as Bethesda Memorial), has been a cornerstone of South Palm Beach County since 1959. The new Bethesda Hospital West opened its doors on January 8, 2013, ready to serve the expanding western communities of South Palm Beach County. Bethesda Health is also an Accredited Chest Pain Center, an Accredited Heart Failure Program, and Joint Commission certified in Hip and Knee Replacement Surgery. Bethesda Health employs over 2,500 employees and has 675 physicians. We invite you to join us now as we expand upon our promise to be the voice for each and every patient and nurse, providing quality health services in a caring manner.

Description

The Physician Advisor (PA) serves as a clinical resource to the medical staff and CM/SW by providing identification, facilitation and resolution of utilization issues. The PA role has a matrix reporting structure which includes Corporate Physician Advisor and Corporate CQIO, as well as entity CMO and CEO. The Physician Advisor addresses the following issues: Federal and state compliance, documentation supporting coding/medical necessity/clinical validation, appropriate level of care, length of stay, hospital utilization and quality issues. In collaboration with admitting physician, healthcare team, and case management, the PA proactively manages cases at the point of entry and through the hospital stay, to ensure the patient is placed in the proper level of care classification based on medical necessity, severity of illness and risk of mortality. The PA ensures compliance with CMS for appropriate billing. The PA conducts post-discharge reviews related to payer audits. Promotes understanding and cooperation between the medical staff through communication, collaboration and education. Facilitate improvements in clinical practice to achieve better performance, improved cost, reduced length of stay, fewer readmissions, and superior patient care.

Full-Time Opportunity (Job ID: FY26-MIA-CC-00)

Provide physician-level leadership regarding federal and state compliance, documentation supporting coding, medical necessity and clinical validation, appropriate levels of care, length of stay, hospital utilization, and quality matters.

Collaborate with admitting physicians, Case Management, and the healthcare team to proactively manage cases from admission through discharge and ensure appropriate level-of-care classifications based on medical necessity, severity of illness, and risk of mortality.

Meet with Case Management and Denials and Appeals teams to review selected cases, recommend the appropriate level and progression of care, and communicate with payer medical directors to facilitate approvals and prevent avoidable denials or carved-out days.

Serve as a consultant and educational resource for physicians and other providers regarding hospitalization, continued stays, resource utilization, payer requirements, utilization and quality regulations, alternative levels of care, community resources, and end-of-life care.

Advise Emergency Department for physicians and Case Management teams regarding patient-status determinations and alternatives to acute care when inpatient treatment is not medically warranted.

Conduct second-level medical-record reviews, patient-status and length-of-stay determinations, post-discharge payer-audit reviews, and Medicare and Medicaid billing recommendations, including inpatient Part B, Condition Code 44, and other CMS contractor requirements.

Support denial-management efforts through payer peer-to-peer discussions, secondary appeal reviews, and contributions to appeal letters.

Review long-stay cases and identify appropriate transitions to skilled nursing, palliative care, long-term care, assisted living, long-term acute care hospitals, hospice, or other lower levels of care.

Promote continuity of care, appropriate resource utilization, reduced lengths of stay, and fewer avoidable readmissions.

Recommend complete and accurate medical-record documentation and support clinical documentation integrity, coding, clinical validation, quality improvement, and evidence-based care initiatives requiring physician input.

Document reviews, recommendations, decisions, and responses to referrals in the electronic health record while appropriately applying InterQual and MCG criteria, the CMS Two-Midnight Rule, current insurance regulations, and established quality metrics.

Participate in entity and system utilization-review committees, peer-review activities, medical staff and leadership presentations, length-of-stay reduction initiatives, utilization-management program evaluations, provider education, and order-set development and implementation.

Maintain professional independence and disclose potential conflicts of interest. Physician Advisors may not review their own patient assignments while serving in an advisory capacity.

Compensation is commensurate with training and experience. Benefits are designed to support professional and personal growth and include medical and dental coverage, generous paid time off, CME opportunities, retirement benefits, access to Baptist Health University for professional development, and more.

In addition, Florida has no state individual income tax.

Qualifications

Requirements include an MD or DO degree and an active, unrestricted medical license. If the license is not issued by the State of Florida, an active Florida medical license must be obtained within one year of hire or entry into the position.

Physician Advisor certification from a nationally recognized physician advisor organization, ABQAURP certification, or a comparable credential must be obtained within one year of hire.

Minimum of three years of experience as a practicing physician, including experience performing case reviews.

Experience applying MCG and/or InterQual criteria, with knowledge of the CMS Two-Midnight Rule, Conditions of Participation, inpatient billing requirements, utilization management, and quality principles.

Ability to accurately analyze, organize, and prioritize work while managing multiple deadlines; communicate effectively in written and verbal form; use critical thinking and professional composure in difficult or stressful situations; exercise sound independent judgment; and use job-related technology and software applications.

Commitment to maintaining current knowledge of CMS guidelines, quality standards, and utilization-management practices through continuing medical education and independent study.

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EOE