Corporate Physician Advisor, Case Management, FT, 8A-4:30P

Corporate Physician Advisor, Case Management, FT, 8A-4:30P-146034

Baptist Health South Florida is the region’s largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. Baptist Health is supported by philanthropy and committed to its faith-based charitable mission of medical excellence.

Our mission, vision, and values make us who we are at Baptist Health and are at the center of everything we do. At Baptist Health, we positively impact the human experience for patients, employees, and physicians. Our success comes from a culture of quality and dedication that is instilled into every member of the Baptist Health family.

This year, and for 24 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, based on employee feedback. We’ve also been recognized as one of America’s Most Innovative Companies and People Magazine included us in 50 Companies That Care. Based on the U.S. News & World Report 2023-2024 Best Hospital Rankings, Baptist Health is the most awarded healthcare system in South Florida, with its hospitals and institutes earning 45 high-performing honors.

But really, the reason we’re excited to come to work is the people.

Working together, we form personal connections with our colleagues that are stronger than most of us have experienced at other jobs. We develop caring relationships with our patients and their families that go beyond just delivering healthcare. After all, we know what it’s like to be in their shoes. Many of us have been patients here and have had family members as patients here. We’re committed to delivering quality care in the most compassionate way possible because we feel a personal stake in the outcomes. When it comes to caring for people, we’re all in.

Description

The Corporate Physician Advisor (CPA) serves as a clinical resource to the medical staff , Case Management and Denials and Appeals teams, by providing identification, facilitation and resolution of utilization issues. The Corporate PA reports directly to the Corporate Chief Quality and Informatics Officer and collaborates with the Corporate VP of Case Management on all utilization issues. The Corporate Physician Advisor will lead a team of physician advisors for BHSF and will ensure that those physician advisors follow strict CMS billing guidelines , CMS Conditions of participation, Federal and State laws , and entity approved Utilization Management Plans in order to ensure compliance across the system. The Corporate Physician Advisor addresses the following issues: documentation supporting coding/medical necessity/clinical validation, appropriate level of care, length of stay, hospital utilization and quality issues. The Corporate Physician Advisor promotes understanding and cooperation between the medical staff through communication, collaboration and education. Facilitate improvements in clinical practice to achieve better performance, improved cost, reduced length of stay, fewer readmissions, and superior patient care. Estimated salary range for this position is $232280.22 – $301964.29 / year depending on experience.

Qualifications

Degrees:

• Doctor of Medicine / DO.

Additional Qualifications:

• A minimum of 5 years work experience as practicing physician, with extensive experience performing case reviews, and using MCG and/or Interqual criteria .
• Maintains active State of Florida Medical Doctor license.
• Certification as Physician Advisor.
• American Board of Quality Assurance and Utilization Review Physicians [ABQAURP] certification or similar is preferred.
• Expert knowledge on application of CMS 2 Midnight Rule, and Condition of Participation, and CMS billing requirements .
• Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
• Ability to communicate effectively in both oral and written form.
• Ability to handle difficult and stressful situations with critical thinking and professional composure.
• Ability to understand and follow instructions.
• Ability to exercise sound and independent judgment.
• Knowledge and skill in use of job appropriate technology and software applications.
• Maintains additional education in CMS guidelines, quality and utilization management through continuing medical education programs and self-study.

Minimum Required Experience:

Job

Healthcare Professional Support

Primary Location

Coral Gables

Organization

Corporate

Schedule

Full-time

Job Posting

Nov 7, 2024, 5:00:00 AM

Unposting Date

Ongoing

EOE, including disability/vets

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