Physician Advisor, Miami, Florida,

Baptist Health South Florida and Bethesda Health have merged to launch a new era of healthcare in Palm Beach County. Together, we are developing and sharing best practices that enhance the level of care we deliver to patients and families.

Bethesda Health is a comprehensive, community-based hospital system that has grown with our community. One of the few remaining not-for-profit health systems in Palm Beach County. Our flagship hospital, Bethesda Hospital East (formerly known as Bethesda Memorial), has been a cornerstone of South Palm Beach County since 1959. The new Bethesda Hospital West opened its doors on January 8, 2013, ready to serve the expanding western communities of South Palm Beach County.

Bethesda Health is also an Accredited Chest Pain Center, an Accredited Heart Failure Program, and Joint Commission certified in Hip and Knee Replacement Surgery. Bethesda Health employs over 2,500 employees and has 675 physicians. We invite you to join us now as we expand upon our promise to be the voice for each and every patient and nurse, providing quality health services in a caring manner.

The Physician Advisor (PA) serves as a clinical resource to the medical staff and CM/SW by providing identification, facilitation and resolution of utilization issues. The PA role has a matrix reporting structure which includes Corporate Physician Advisor and Corporate CQIO, as well as entity CMO and CEO. The Physician Advisor addresses the following issues:
Federal and state compliance, documentation supporting coding/medical necessity/clinical validation, appropriate level of care, length of stay, hospital utilization and quality issues. In collaboration with admitting physician, healthcare team, and case management, the PA proactively manages cases at the point of entry and through the hospital stay, to ensure the patient is placed in the proper level of care classification based on medical necessity, severity of illness and risk of mortality.

The PA ensures compliance with CMS for appropriate billing. The PA conducts post-discharge reviews related to payer audits. 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.

Full-Time Opportunity (Job
-MIA-CC-00)

Provide physician-level leadership regarding federal and state compliance, documentation supporting coding, medical necessity and clinical validation, appropriate levels of care, length of stay, hospital utilization, and quality matters.

Collaborate with admitting physicians, Case Management, and the healthcare team to proactively manage cases from admission through discharge and ensure appropriate level-of-care classifications based on medical necessity, severity of illness, and risk of mortality.

Meet with Case Management and Denials and Appeals teams to review selected cases, recommend the appropriate level and progression of care, and communicate with payer medical directors to facilitate approvals and prevent avoidable denials or carved-out days.

Serve as a consultant and educational resource for physicians and other providers regarding hospitalization, continued stays, resource utilization, payer requirements, utilization and quality regulations, alternative levels of care, community resources, and end-of-life care.

Advise Emergency Department for physicians and Case Management teams regarding patient-status determinations and alternatives to acute care when inpatient treatment is not medically warranted.

Conduct second-level medical-record reviews, patient-status and length-of-stay determinations, post-discharge payer-audit reviews, and Medicare and Medicaid billing recommendations, including inpatient Part B, Condition Code 44, and other CMS contractor requirements.

Support denial-management efforts through payer peer-to-peer discussions, secondary appeal reviews, and contributions to appeal letters.

Review long-stay cases and identify appropriate transitions to skilled nursing, palliative care, long-term care, assisted living, long-term acute care hospitals, hospice, or other lower levels of care.

Promote continuity of care, appropriate resource utilization, reduced lengths of stay, and fewer avoidable readmissions.

Recommend complete and accurate medical-record documentation and support clinical documentation integrity, coding, clinical…