Physician Advisor (PA)

Job Description

About Company

Baptist Health is recognized as the largest not-for-profit healthcare organization in its region. It encompasses a vast network including 12 hospitals, over 28,000 employees, 4,500 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spread across Miami-Dade, Monroe, Broward, and Palm Beach counties. The organization boasts internationally renowned centers of excellence in critical areas such as cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences.

Driven by a faith-based mission of medical excellence, Baptist Health is also significantly supported by philanthropy. Its commitment to its employees and quality of work environment is evident as it has been named one of Fortune’s 100 Best Companies to Work For for 25 consecutive years. Furthermore, in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health distinguished itself as the most awarded healthcare system in South Florida, securing 45 high-performing honors.

What truly differentiates Baptist Health is its people-centric culture. The organization fosters personal connections among colleagues that extend beyond the workplace, and it builds meaningful, lasting relationships with patients and their families. Many team members have personal experiences as patients, which deeply fuels their commitment to compassion and quality care. The culture is firmly rooted in purpose, ensuring that every team member plays a vital role in making a positive impact, reflecting the philosophy that “when it comes to caring for people, we’re all in.”

Job Description (Detailed)

The Physician Advisor (PA) serves as a crucial clinical resource, providing expertise to the medical staff and Case Management/Social Work (CM/SW) by identifying, facilitating, and resolving utilization issues. This role operates under a matrix reporting structure, reporting to both the Corporate Physician Advisor and Corporate CQIO, as well as the entity CMO and CEO.

Key Responsibilities and Areas of Focus:

• Compliance and Documentation: Addresses federal and state compliance requirements, ensuring documentation robustly supports coding, medical necessity, and clinical validation.
• Utilization Management: Focuses on appropriate level of care, managing length of stay, and optimizing overall hospital utilization.
• Quality Issues: Identifies and addresses various quality concerns within patient care.
• Proactive Case Management: In close collaboration with the admitting physician, the healthcare team, and case management, the PA proactively manages patient cases from the point of entry through their entire hospital stay. This includes ensuring patients are placed in the correct level of care classification, based on a thorough assessment of medical necessity, severity of illness, and risk of mortality.
• Billing Compliance: Ensures strict compliance with CMS regulations for appropriate billing practices.
• Post-Discharge Reviews: Conducts reviews of cases post-discharge, particularly those related to payer audits.
• Medical Staff Relations: Promotes understanding and fosters cooperation among the medical staff through effective communication, collaboration, and educational initiatives.
• Clinical Practice Improvement: Facilitates improvements in clinical practice aimed at achieving enhanced performance, reduced costs, decreased length of stay, fewer readmissions, and ultimately, superior patient care outcomes.

Qualifications:

• Degrees:
• Must hold a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
• Licenses & Certifications:
• Maintains an active Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) license. If the current license is not from the state of Florida, an active State of Florida License must be obtained within one year of hire/job entry.
• Certification as Physician Advisor by a national physician advisor organization or American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) certification (or a similar certification) must be obtained within one year of hire.
• Minimum Required Experience:
• A minimum of 3 years of work experience as a practicing physician is required.
• This experience must include performing case reviews and proficiency in using MCG and/or Interqual criteria.
• Required Knowledge:
• In-depth knowledge of the application of the CMS 2 Midnight Rule and Condition of Participation.
• Familiarity with inpatient billing requirements.
• Ongoing maintenance of education in CMS guidelines, quality, and utilization management through continuing medical education programs and self-study.
• Required Skills & Abilities:
• Demonstrated ability to analyze, organize, and prioritize work accurately while effectively meeting multiple deadlines.
• Exceptional ability to communicate effectively in both oral and written forms.
• Competence in handling difficult and stressful situations with critical thinking and professional composure.
• Capability to understand and follow instructions precisely.
• Strong ability to exercise sound and independent judgment.
• Proficiency and skill in the use of job-appropriate technology and software applications.