Executive Medical Director Revenue Cycle

AdventHealth - Maitland, FL

Full-time - Senior

Maitland, FL

Hospitals

About the position

The Executive Medical Director of Revenue Cycle at AdventHealth is a key leadership role responsible for overseeing the utilization review, claims management, and quality assurance processes related to inpatient and outpatient care. This position serves as a physician advisor, providing clinical expertise and business direction to ensure high-quality, efficient healthcare services. The role involves collaboration with various departments and external stakeholders to improve care delivery and manage relationships with health insurance payers and regulatory agencies.

Responsibilities

• Educate and advise members of various departments on denial prevention measures and updates related to managed care payers.
• Review and authorize inpatient days and evaluate utilization patterns to identify areas for improvement.
• Collaborate with Senior Medical Officers regarding utilization review management activities.
• Review and respond to complaints and indicators, working closely with Utilization Review Management staff.
• Make recommendations on appealed provider claims and determinations for appeals and grievances.
• Participate in the development of medical guidelines and policies with the Medical Directorate.
• Advise and educate Care Managers on clinical issues and utilization determinations.
• Conduct regular meetings with Care Managers to ensure continuity and efficiency in inpatient settings.
• Develop clinical care pathways and utilization benchmarking for specialty groups.
• Manage specialty-specific quality screens and utilization outliers.
• Collaborate with payers and community health resources to monitor and reduce unnecessary length of stay.
• Educate and serve as a resource to Medical Staff on best practices and clinical guidelines.

Requirements

• Graduate from medical school and residency program.
• Current, valid State of Florida license as a physician.
• Board certified and eligible for membership on the Hospital medical staff.
• Ten years of recent clinical practice experience.
• Seven years of leadership experience.

Nice-to-haves

• Master's degree in Business or Healthcare Administration.
• Understanding of Hospital Care Management, including Utilization Management.
• Two years or greater experience as a Physician Advisor.

Benefits

• Benefits from Day One
• Paid Days Off from Day One
• Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense)