Physician Advisor MD

Position Summary

Baptist Health Brookwood is part of the Orlando Health system of care, which includes award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and inpatient facilities that span Florida's east to west coasts, Central Alabama and Puerto Rico. Collectively, our team members honor our over 100-year legacy by providing professional and compassionate care to the patients, families and communities we serve.

Baptist Health Brookwood Hospital Offers Great NEW Competitive Pay and Great Benefits Package that Includes:

• Medical, Dental, Vision
• 403(b) Retirement Savings Plan
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Paid Time Off (up to 5 weeks to start)
• Life Insurance
• Extended Leave Plan (ELP)
• Family Care (childcare, elder care, pet care)
• Paid Parental Leave
• Pet Insurance
• Car Insurance
• Educational Benefits including tuition reimbursement & monthly payments to help pay down any graduated school debt

ALL Benefits Start Day One!

Position Summary

The Physician Advisor (PA) will act as a liaison between the medical staff, revenue cycle, physician leadership teams, and hospital administration teams ensuring that the system is optimized for regulatory compliance, medical necessity, and efficient utilization of healthcare services.

The PA conducts clinical reviews on cases in accordance with the hospitals objectives for assuring quality patient care and effective clinical documentation.

Essential Functions

• The PA meets with care management and health care team members to discuss selected cases and make recommendations for care, interacting with medical staff members and medical directors of third-party payers to discuss the needs of patients and alternative levels of care.
• The PA acts as consultant to and resource for providers regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
• The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations.
• Acts as second-level reviewer through the review of medical records of patients identified by care managers or as requested by the healthcare or administration teams.
• Assist with the patient status determination (level of care) and length of stay management.
• Assist with the denial management process.
• Review and make suggestions related to resource and service management.
• Assist staff with the clinical review of patients.
• Determine if professionally recognized standards of quality care are met.
• Optimization of the observation rates and observation length of stay.
• Provides feedback to providers regarding level of care, length of stay, and quality issues. Seeks additional clinical information from the providers. Recommends and requests additional, more complete, medical record documentation. Recommends next steps in coordination of care and evidence-based medicine indicators.
• Reviews cases that indicate a need for issuance of a hospital notice of non-coverage/Important Message from Medicare. Discusses the case with the attending physician and if additional clinical information is not available, discusses the process for issuance and appeal to the physician.
• Documents in patients’ electronic health record (HER) care reviews, decisions, and other pertinent information. Understands and uses Inter Qual and other appropriate criteria. Documents response to case management referrals. Supports Care Management in a data-driven approach.
• Notifies the care manager of any conflict of interest in reviewing a patient’s record. Assists with identifying a physician to review such record.
• Acts as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate. Facilitates, mentors, and educates other providers regarding payer requirements.
• Participates in review of long stay patients, in conjunction with the Care Management Leadership, Care Management Team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care. Participates in patient rounds with the healthcare team as indicated.
• Identifies patients who are appropriate for…