Physician Advisor, Jackson Memorial Hospital, Per Diem, Variable weekends & holidays

Jackson Health•Miami, FL

12d•Onsite

About The Position

The Physician Advisor (PA) acts as a clinical resource for the medical staff and Care Management/Social Work (CM/SW) team, focusing on the identification, facilitation, and resolution of utilization issues. This role reports to the Chief Medical Officer, Chief Utilization Officer, or their designee. Key responsibilities include addressing issues related to level of care, payer peer-to-peer correspondence, documentation, compliance, discharge planning, hospital reimbursement, and quality. The Physician Advisor also ensures proper status determination with support from CM/SW and promotes understanding and cooperation among medical staff through communication, collaboration, and education.

Requirements

Experience as a hospitalist, physician advisor, or experience with utilization review or CDI.
MD or DO degree (US or FMG) is required.
House Physician license must be obtained within 90 days of hire.
Active Florida medical license or house physician license (or eligibility) is required.

Nice To Haves

Knowledge of, and experience with InterQual, MCG, and major payor classes is desirable.
Foreign Medical Graduate with experience in utilization review, CDI, InterQual, MCG preferable.
ABQAURP certification is preferred.

Responsibilities

Round to various units with unit nurse managers, case managers, and social workers to bridge with medical teams, ensuring appropriate level of care determination, improved documentation, appropriate utilization, and discharge planning.
Participate in the review of long-stay patients, in conjunction with Care Management Leadership, Care Management Team, and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care.
Support multidisciplinary team meetings and individual family meetings as part of discharge planning.
Provide education to physicians and other clinicians regarding optimal use of the ICU and other limited resources.
Document patient care reviews, decisions, and other pertinent information as requested.
Understand and use InterQual, MCG, and other appropriate criteria.
Identify patients appropriate for transfer to LTACH, SNF, or other facilities and work with physicians to facilitate referrals as needed.
Work with Care Management and interdisciplinary teams to ensure appropriate continuity of care and to reduce readmissions.
Communicate with payors to justify admissions and overturn denials as appropriate, including peer-to-peer/doc-to-doc communication.
Act as a resource for attending physicians, residents, and providers to support appropriate admission, continued stay, and utilization of resources for their patients.
Provide feedback and education to other physicians and providers regarding payer requirements, level of care, length of stay, appropriate utilization, community resources, end of life care, quality improvement, and other necessary information.
Promote and participate in hospital quality and performance improvement programs and support engagement of physicians and other providers in these activities.
Serve as liaison between the CDI professional, HIM, and other physicians and providers to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity, and risk of mortality, in addition to DRG assignment.
Educate physicians and providers about clinical documentation to support admission, ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology, DRG assignments, E&M coding, HCC coding, and other documentation topics which may include their individual patient records.
Educate specific medical staff departments (e.g., Internal Medicine, Surgery, Family Practice, etc.) regarding documentation issues and their link to quality and performance measures.
Role model behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
Perform all other related job duties as assigned.