Physician AdvisorOrlando, FL

Job Opportunity At AdventHealth Orlando

At AdventHealth Orlando, what started as a converted farmhouse in rural Central Florida has become Central Florida's major tertiary health care facility. Patients come from the Southeast, the Caribbean and even as far as South America for our proven expertise and compassionate health care.

With a variety of Orlando hospital jobs, we invite you to start or elevate your career with a new job at AdventHealth Orlando. We constantly seek out Orlando nurses, medical assistants, nurse assistants, patient care and health administration professionals who share our passion for whole-person health care. Learn more about our open positions and apply to become an invaluable part of our team.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Days Off from Day One
• Student Loan Repayment Program
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support
• Pet Insurance*
• Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)

Schedule: Full Time

Shift: Monday - Friday 8:00am - 5:00pm

Location: AdventHealth Orlando

• Faith based & mission driven organization
• Central Florida's premier multi-specialty medical group
• Comprehensive Employee Benefits such as Educational Reimbursement
• CREATION Health employee wellness and lifestyle programs
• Positive working climate to support a work life balance

Principal Duties and Job Responsibilities:

• Provides clinical support/validation for Care Management, CDI and Quality teams.
• Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures, and functions and use of clinical guidelines.
• Develops and facilitates productive internal/external relationships with all physicians and constituents of Utilization Management, Care Management and CDI departments.
• Provides suggested approaches to clarifying clinical questions when Utilization Management and Care Management staff interact with physicians, nurses, or other health professionals.
• Maintains a positive and supportive relationship between the inpatient facilities, payors and physicians (hospitalist groups and primary care providers), and acts as the interdepartmental liaison for program development.
• Educate medical staff on correlation between clinical language, coding guidelines, severity of illness, risk of mortality and DRG assignment.
• Explain importance of correct disease reporting and ICD code capture for physician/hospital performance profiling, E&M payment, pay-for-performance and hospital reimbursement.
• Educate hospital physicians on ICD-10 and DRG coding guidelines to enhance understanding of severity, acuity, risk of mortality and DRG assignments.
• Attend departmental meetings to teach medical staff about coding and documentation improvement guidelines, clinical documentation improvement opportunities and relevant data.
• Provide physician coaching on documentation.
• Assist in billing for technical component of services and appeals for denials.
• Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review, and denials as a back up to UM Physician Advisory as and when needed.
• Assists with interpretation of specific application of medical necessity criteria
• Responsible for reviewing Clinical Documentation and performs secondary review for escalations
• Evaluates and reviews charts for Quality indicators as part of QSR process within CDI
• Assists in formulation of reasonable clinical arguments to address any questions regarding level of care
• May performs peer-to-peer discussions with payer Medical Directors and/or discusses cases with payer representatives to facilitate claim resolution and build payer relationships when needed
• Report and collaborates with Chief Medical Officers, CFOs and acts as a liaison between Care Management and the Hospital's Medical Staff
• Reviews key performance indicators and progress to targets; reviews data and trends to identify opportunities for Length of Stay improvement to positively influence practice patterns and address avoidable delays.
• Conducts regular, ongoing meetings with Care Management to ensure continuity and efficiency in the inpatient setting, as well as, educate on common problematic clinical issues
• Provides guidance to clinical questions from Care Management staff regarding appropriateness of placement in terms of patient's clinical status/care needs
• Supports long stay meetings to effectively manage length of stay. Generates clinically sound alternative ideas and approaches to complex and/or long stay patients.
• Provides multidisciplinary, "big picture" approaches that coordinate clinical, psychosocial, payor, financial and other needs.
• Promotes communication of expected discharge date with multidisciplinary team, patients and families
• Collaborates with Clinical Documentation Integrity leadership and meets at least quarterly to assist in the identification of clinical documentation improvement opportunities
• Assists in the review and revision processes of current clinical care pathways while providing insight and input on future pathway development. Escalates concerns to Facility Chief Medical Officer, CFOs as appropriate.
• Serves as a member of the Medical Staff Committees and other clinical and/or finance related groups as determined by the Chief Medical Officer in order to build trusting relationships and share observations and provider improvement opportunities.
• Collaborates with Medical Director(s) to review and provide insight regarding medical guidelines and policies.
• Assists in other duties related to utilization management, clinical documentation and quality improvement of the network as assigned by the Chief Medical Officer
• Supports compliance with all State and Federal regulations

Qualifications

Knowledge and skills required:

• Strong organization skills with attention to detail
• Excellent analytical and problem-solving skills
• Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff
• Ability to work in a matrix-management environment to achieve organizational goals
• Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike
• Demonstrated ability to provide expert medical advice
• Practicing Physician with Direct patient care experience of over 10 years
• Demonstrated ability to build and sustain relationships in the medical community and a corporate environment
• Payor experience in operations

Education required:

• Graduate from medical school and residency program

Education preferred:

• Master's degree in Business or Healthcare Administration or related degree

Experience required:

• Five or more years recent clinical practice experience

Experience preferred:

• Understanding of hospital Utilization Management/Medicare Regulations
• Two years or greater experience as a Physician Advisor
• Three years of leadership experience

Licensure, certification, or registration required:

• Current, valid State of Florida license as a physician
• Board certified and eligible for membership on the hospital medical staff

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Physician Services

Organization: AdventHealth Orlando

Schedule: Full-time

Shift: 1 - Day

Req ID: 25007240

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment