Medical Director Physician Advisor PRN at AdventHealth

Date Posted: 9/13/2019

Job Snapshot

  • Job Schedule
    Per Diem
  • Location:
    Tampa, FL
  • Job Category
  • Date Posted:
    9/13/2019
  • Job ID:
    19014555
  • Job Family
    Physician Services
  • Travel
    Yes, 50 % of the Time
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Tampa

Job Description


Description

Medical Director Physician Advisor AdventHealth Tampa

Location Address: 3100 East Fletcher Avenue Tampa, Florida 33613

Top Reasons to Work at AdventHealth Tampa

  • Florida Hospital Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
  • Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
  • Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
  • Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.

Work Hours/Shift:

PRN/Days

You Will Be Responsible For:

  • Responsible for reviewing and authorizing inpatient days and the evaluation of inpatient utilization patterns within service areas to identify areas of improvement, developing specific strategies and criteria addressing areas of need.  Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive and supportive relationship between the inpatient facilities, health plans and physicians (hospitalist groups and primary care providers), as well as interdepartmental liaison for ACO activities and program development.  Reviews and responds to Complaints & Indicators. Works in close coordination with the processes of the Utilization Review Management staff for continual process improvement and reporting.  Reviews and makes recommendations on appealed provider claims and makes determinations for appeals & grievances.  Provides support, shares administrative call, and maintains collaborative relations with the other medical directors.
  • Participates with the Medical Directorate to review and develop medical guidelines and policies.  Advise and educate Care Managers regarding clinical issues. Act as liaison for and attending physicians to arrive at most appropriate inpatient/outpatient utilization determinations.  Assists in other duties related to utilization review and quality improvement of the network as assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director, Utilization Review Management.
  • Reviews data and trends to identify opportunities for utilization improvement to positively influence practice patterns.  Conducts regular, ongoing meetings with Care Managers to ensure continuity and efficiency in the inpatient setting.  Performs other duties as assigned.  Develops clinical care pathways and utilization benchmarking for specialty groups within the West Florida Division.  Manages specialty-specific quality screens and utilization outliers. 
  • Collaborates and develops relationships with payers and the community health resources.  Actively contributes in efforts to monitor and reduce unnecessary length of stay.  Participates in review of long stay patients, in conjunction with the Director of Utilization Review Management to facilitate the use of the most appropriate level of care.  Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Care Management structure, and functions and uses of clinical guidelines.  Develops and facilitates productive internal/external relationships with all physicians and constituents of Care Management. 
  • Acts as a liaison between contracted Managed Care/Commercial payers related to managed care denials, Care Management and the Hospital’s Medical Staff to facilitate the accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, in addition to DRG assignment.  Establishes and maintains a presence within the Medical Staff structure and active participation on applicable committees (ie JOC/Payer, Revenue Cycle, Finance Committee, etc.).
  • Conducts clinical reviews on cases referred by care management staff and/or other health care professionals to meet regulatory requirements and in accordance with the hospital objectives for assuring quality patient care.
  • Remain up to date with all pertinent federal and state regulations, law, and policies, and ensure compliance with regulatory matters.  Facilitate distribution of relevant information to hospital clinical staff when appropriate and serve as a subject matter expert and educational resource.

Qualifications

What You Will Need:

  • Graduate from medical school and residency program
  • Minimum five (5) years recent clinical practice experience
  • Current and valid State of Florida license as a physician
  • Board certified and eligible for membership on the Hospital medical staff

Job Summary:

As the physician advisor, the Medical Director (MD) of Utilization Review Management educates, informs, and advises members of the Case Management, Revenue Cycle, Patient Financial Services, Patient Access, AHS Managed Care departments and applicable Medical Staff of specific updates, statistical trending and/or changes related to denial prevention measures for our contracted managed care payers.  Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.  The Medical Director is responsible for providing physician review of utilization, claims management, and quality assurance related to inpatient care.  This position supports the CMO capacities at the facilities within the West Florida Division by ensuring the delivery of high-quality, efficient healthcare services throughout the continuum of care for the membership served by contracted medical group provider networks.  The Medical Director is an important contact for clinicians, external providers, contracted health insurance payers, and regulatory agencies.  It also serves as subject matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient focused and cost-effective medical care.



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

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