Physician Advisor

Location: West Panhandle, FL
Date Posted: 03-26-2018
Physician Advisor - West Panhandle, FL

About the Client:
The first hospital in the area to offer all private rooms, our client proudly provides market-leading quality outcomes performance. Our client is also recognized as the area’s first Accredited Chest Pain Center with PCI, the area’s first Breast Imaging Center of Excellence, and the area’s only Certified Atrial Fibrillation Program. Our client has also been designated as an Advanced Primary Stroke Center and has been named as a “Key Performer on Quality Measures” by The Joint Commission for four years in a row. The hospital campus includes the all private room acute care hospital, the area’s only comprehensive, CARF-accredited physical rehabilitation hospital, a mental health facility, and a cancer center. Affiliated with the nation’s leading provider of healthcare, our meets the community’s healthcare needs in major services such as oncology, orthopedics, cardiology, cardiovascular surgery, robotic-assisted surgery, critical care, neurology/neurosurgery, emergency care, urology, behavioral health, gastroenterology, obstetrics, pulmonary, and rehabilitative medicine.

Position Summary:
  • Upon referral and/or request from hospital or committees, evaluates the medical necessity, appropriateness, and quality of care that patients of all ages receive when hospitalized.
  • Works with physicians on an ongoing basis to inform, educate, and advise regarding patient care and hospital operations and changes.
  • Analyzes data to determine areas of improvement for the hospital and medical staff.
  • Provides medical expertise for determining community, hospital, and patient needs to improve overall medical care provided within the community.
  • This position requires the full understanding and active participation in fulfilling the mission of the organization.  It is expected that the employee will demonstrate behavior consistent with the core values.

Education/Training/Experience: 
  • Clinical practice with understanding of utilization review, case management, quality management, and resource control. 
  • Served as medical staff department chairman and/or Medical Executive Committee.
  • Demonstrated cost efficient practice other qualification. 
  • Experience preferred in performance improvement process, data analysis, computers, and communication skills.

 Licenses/Certifications: 
  • Licensed Florida physician
  • Prefer board certification in ABQARP

Principal Duties and Responsibilities:
Provide clinical reviews in accordance with Managed Care and CMS Regulatory Requirements to:
  • Assist with level of care and length of stay management on a case-by-case basis
  • Assist with the denial management process
  • Determine if professionally recognized standards of quality care are met
  • Participate in the concurrent and retrospective appeal peer-review process
  • Provide feedback to internal and external partners regarding level of care, length of stay and quality issues, which may also include joining client meetings to review observations and trends in physician behavior and/or documentation.
  • Recommend and request additional, more complete, medical record documentation.
  • Provide guidance to internal and external staff regarding status issues and alternatives to acute level of care when such care is not warranted.
  • Provide education to internal and external staff related to regulatory requirements, appropriate utilization, and alternative levels of care.\
  • Ensure appropriate documentation of patient care reviews, decisions, and other pertinent information. Be able to review cases with screening criteria.
  • Coding background is a plus. Proper coding for reimbursements. Coding for insurance propose and utilization review.
  • Chart Reviews
  • Having conversations with doctors and staff.
  • Saving hospital money insuring that they are using correct protocols
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