Physician Advisor: Utilization & Care Quality Leader

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 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