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)

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time

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

Location: 4633 VINELAND RD, Orlando, 32811

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

KNOWLEDGE AND SKILLS PREFERRED:

Direct involvement with supporting the development of a Utilization Management and Care Management departments

Board Certified by ABQAURP

Knowledge of change management principles, methodologies, and tools

EDUCATION AND EXPERIENCE REQUIRED:

Graduate of accredited Medical School

Bachelor of Science

Minimum of 5 years of experience in medicine in acute care setting

EDUCATION AND EXPERIENCE PREFERRED:

Master’s degree in Business or Healthcare Administration

Two (2) years or greater experience as a Physician Advisor

Prior experience with third party payors preferred

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

Current and valid license as a physician

Board certified in their field of practice

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

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, selection, placement, promotion, wages, benefits and other terms and conditions of employment.