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Benefits from Day One
Paid Days Off from Day One
Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)
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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.).
Compliance/Regulatory Responsibility
Educates, consults, and advises members of the Medical Staff on regulatory updates and changes related to Care Management.
Serves as a member of the Utilization Management (UM) Committee by ensuring committee is actively reviewing and acting upon trends identified through data. Provides trend data of denials to assist in improving payer or care delivery behavior.
Operating & Capital Budget/Financial Responsibility
Aid in supporting Length of Stay (LOS) and quality goals.
Reviews concurrent payer denials and intervenes with attending and/or consulting physicians and managed care medical directors, as needed, for reconsideration and denial avoidance.
Strategic Planning Responsibility
Provides input on developing plans for physician education to meet identified needs and provides information to members of the Medical Staff and clinical departments on Care Management guidelines and protocols.
Performance Improvement Responsibility
Provides teaching and guidance to key associates and physicians regarding the impact of responsible stewardship of resources and attainment of important outcomes for each patient and family.
Responsible for managing the efficiency of inpatient care delivered in the organization and collaborates with all levels of managed care team, utilization review management, hospital executive team including the Chief Medical Officers, and leadership of medical and nursing staff.
Serves as a liaison between the AHS Managed Care Operations, Care Management, PFS, Revenue Cycle, Utilization Review departments, Medical Staff and the Chief Medical Officers for matters related to physician practice and behaviors as they affect cost, quality, documentation and patient outcomes.
Community Relations Responsibility
Develops and fosters relationships with community post-acute care partners to ensure effective communication on patient’s continuum of care practices resulting in optimum patient outcomes
Qualifications
Education Required
The expertise and experiences you'll need to succeed:
Graduate from medical school and residency program
Education Preferred
Master’s degree in Business or Healthcare Administration
Experience Required
Ten years recent clinical practice experience
Seven years of leadership experience
Experience Preferred
Understanding of Hospital Care Management, including Utilization Management
Two years or greater experience as a Physician Advisor
Licensure, Certification, Or Registration Required
Current, valid State of Florida license as a physician
Board certified and eligible for membership on the Hospital medical staff
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical
Seniority level
Not Applicable
Employment type
Full-time
Job function
Other
Industries
Hospitals and Health Care
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