Physician Advisor - ICM

Þpartment Integrated Case Management Job Summary This dynamic full-time Physician Advisor provides 1) physician administrative support and leadership to the utilization and resource management areas of Integrated Case Management including mentoring/coaching Care Coordinators, Utilization Review staff, and Social Workers, 2) reviewing cases for medical necessity, 3) daily multi-disciplinary rounds, 4) collaborating with hospitalists, physicians, and house staff in determining appropriate inpatient versus outpatient/observation status, and providing feed-back on documentation improvement opportunities 5) participating in third-party payor denial, appeal, and peer-to-peer processes. Identifying and benchmarking standards of best practice related to throughput, efficiency, length of stay, resource utilization, high quality admissions, readmission avoidance, and transitions of care across the continuum is an organizational standard. The physician advisor will consider compliance with regulatory and payor requirements, policy and organizational goals, and quality patient outcomes when performing patient reviews. This position will be an active member of the Utilization Review Committee. Required Qualifications MD or DO from an accredited school of medicine Board Certification Active Florida medical license Qualified as a provider under Medicare and Medicaid Current medical staff privileges or the ability to be credentialed for staff privileges at any Sarasota Memorial Health Care System hospital A minimum of three (3) years of hospital acute care experience with exposure to utilization management and documentation initiatives A minimum of one (1) year of leadership experience Experience in case management, care coordination, and utilization management Maintains current knowledge of federal, state, and payor regulatory and contract requirements Demonstrated teamwork, performance analysis, presentation, facilitation, planning, and communication skills. Ability to maintain positive rapport with hospital and departmental leadership, case management staff, and physicians Preferred Qualifications Internal Medicine or Family Medicine Previous experience as a physician advisor Experience in managed care contracting and familiarity with Medicare and managed care reimbursement policies Preferred License and Certs ABQAURP (American Board of Quality Assurance and Utilization Review Physicians), with a physician advisor sub-specialty