AdventHealth is hiring a Physician Advisor to play a key role in optimizing inpatient care delivery and resource utilization. In this position, you will ensure the clinical appropriateness of patient stays while fostering collaboration between our medical staff, health plans, and care teams.
What You'll Do
- Review and authorize inpatient days and evaluate inpatient utilization patterns to identify areas of improvement.
- Develop specific strategies and criteria addressing areas of need.
- Collaborate with Senior Medical Officers from contracted managed care payers regarding utilization review activities.
- Maintain a positive and supportive relationship between inpatient facilities, health plans, and physicians.
- Work in close coordination with Utilization Review Management staff for continual process improvement and reporting.
- Review and make recommendations on appealed provider claims.
- Provide support, share administrative call, and maintain collaborative relations with other medical directors.
- Advise and educate Utilization Management staff regarding clinical issues.
- Act as liaison for and with attending physicians to arrive at the most appropriate inpatient/outpatient utilization determinations.
- Review data and trends to identify opportunities for utilization improvement to positively influence practice patterns.
- Conduct regular, ongoing meetings with Utilization Management to ensure continuity and efficiency in the inpatient setting.
- Develop utilization benchmarking for specialty groups within the Orlando market.
- Manage specialty-specific quality screens and utilization outliers.
- Act as a liaison between contracted payers, Utilization Management, and Medical Staff to facilitate accurate documentation for coding and DRG assignment.
- Establish and maintain a presence within the Medical Staff structure and actively participate on applicable committees.
- Educate, consult, and advise Medical Staff on regulatory updates related to Care and Utilization Management.
- Serve as an active participating member of the Utilization Management Committee, ensuring it reviews and acts upon identified trends.
- Provide trend data of denials to assist in improving payer or care delivery behavior.
- Aid in supporting Length of Stay strategies and quality goals.
- Review concurrent payer denials and intervene with physicians and managed care medical directors for reconsideration.
- Provide input on developing plans for physician education to meet identified needs.
- Provide information to Medical Staff and clinical departments on Utilization Management guidelines and protocols.
What We're Looking For
- Graduate from medical school and residency program.
- 5+ years of recent clinical practice.
- MD - Physician - State Licensure FL.
- Board certified and eligible for membership on the hospital medical staff.
Team & Environment
You will work in close coordination with Utilization Review Management staff, provide support and share administrative call with other medical directors, and report to the Division CFO/Sr VP, Vice President of Revenue Cycle Operations, and/or Executive Director Middle Revenue Cycle/Utilization Management.
Benefits & Compensation
- Compensation: $206,606.17 - $413,212.34
- Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
- Paid Time Off from Day One
- 403-B Retirement Plan
- 4 Weeks 100% Paid Parental Leave
- Career Development
- Whole Person Well-being Resources
- Mental Health Resources and Support
- Pet Benefits
Work Mode
This role is onsite in ORLANDO, Florida.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
