Physician Advisor, REMOTE HYBRID, West Kendall Baptist Hospital, Administration, FT, 8A -4:30P

Baptist Health; Miami (FL); Remote; USD 150,000 - 200,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Physician Advisor to enhance patient care and ensure compliance with regulations. In this pivotal role, you will collaborate with medical staff to manage cases effectively, addressing utilization issues and promoting best practices in clinical care. Your expertise will guide the healthcare team in navigating complex compliance requirements while fostering a culture of quality and compassion. Join a mission-driven organization that values personal connections and strives for excellence in patient outcomes.

Qualifications

• 3+ years of experience as a practicing physician with case review expertise.
• Certification as Physician Advisor required within one year of hire.

Responsibilities

• Serve as a clinical resource to address utilization issues and ensure compliance.
• Proactively manage cases to classify patients based on medical necessity.

Skills

Clinical Resource Management

Critical Thinking

Communication Skills

Case Management

Education

Doctor of Medicine (MD)

Doctor of Osteopathic Medicine (DO)

Tools

MCG criteria

Interqual criteria

CMS Guidelines

Job description

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors.

What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact - because when it comes to caring for people, we're all in.

Description:

The Physician Advisor serves as a clinical resource to the medical staff and CM/SW by providing identification, facilitation and resolution of utilization issues. The Physician Advisor 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.

Qualifications:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required.
• A minimum of 3 of years work experience as practicing physician, with experience performing case reviews, and experience using MCG and/or Interqual criteria.
• Certification as Physician Advisor by a national physician advisor organization or American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) certification or similar must be obtained within one year of hire.
• Knowledge on application of CMS 2 Midnight Rule, and Condition of Participation, and inpatient billing requirements.
• Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment.
• Knowledge and skill in use of job appropriate technology and software applications. Maintains additional education in CMS guidelines, quality and utilization management through continuing medical education programs and self-study.

EOE