Physician Advisor - Entity, Administration-BHM, FT, 8:30A -5P

Baptist Health South Florida is the region’s largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. Baptist Health is supported by philanthropy and committed to its faith-based charitable mission of medical excellence.

Our mission, vision, and values make us who we are at Baptist Health and are at the center of everything we do. At Baptist Health, we positively impact the human experience for patients, employees, and physicians. Our success comes from a culture of quality and dedication that is instilled into every member of the Baptist Health family.

This year, and for 24 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, based on employee feedback. We’ve also been recognized as one of America’s Most Innovative Companies and People Magazine included us in 50 Companies That Care. Based on the U.S. News & World Report 2023-2024 Best Hospital Rankings, Baptist Health is the most awarded healthcare system in South Florida, with its hospitals and institutes earning 45 high-performing honors.

But really, the reason we’re excited to come to work is the people.

Working together, we form personal connections with our colleagues that are stronger than most of us have experienced at other jobs. We develop caring relationships with our patients and their families that go beyond just delivering healthcare. After all, we know what it’s like to be in their shoes. Many of us have been patients here and have had family members as patients here. We’re committed to delivering quality care in the most compassionate way possible because we feel a personal stake in the outcomes. 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. 

JOB ID: 145311

We are proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.