Tampa General Hospital | Physician Advisor, Hospital ...

Job Summary The Physician Advisor, reporting to the Director of Physician Advisor and under the direction of the VP of Hospital Medicine and Associate Chief Medical Officer, optimizes patient care, resource management, and regulatory compliance within the health system. The PA collaborates with medical staff, hospital leadership, and multidisciplinary teams, including Case Management, Utilization Management, and Revenue Cycle, to develop care management protocols, support documentation, and coding compliance, support revenue cycle operations, and ensure appropriate utilization of hospital resources. Essential Functions: Conduct medical necessity reviews, including initial, secondary, and continued stay, ensuring compliance with utilization standards. Manage observation status and assist with optimizing patient length of stay and throughput. Lead Utilization Management Committees (UMC) and participate in denial management processes, including peer-to-peer reviews and appeals. Determine medical necessity for post-acute discharge placement and support timely discharges. Educate and mentor physicians and providers on clinical documentation, medical necessity, and payer requirements. Provide actionable feedback to physicians and stakeholders on utilization, length of stay, and quality performance metrics. Support regulatory audits, investigations, and inpatient stay reviews to ensure compliance with hospital standards and payer guidelines. Implement strategies to reduce inappropriate admissions, complication, and readmissions through multidisciplinary collaboration. Document care review, decisions, and appeals as required by hospital policy, providing clinical rationale for utilization decisions. Track and analyze denial trends to identify opportunities for process improvement and payer-related adaptations. Qualifications Education: Graduate of an accredited School of Medicine. Completion of an accredited residency program & MD. Master's degree in Management, Health Care, Business Administration, or related field preferred. Hospitalist experience preferred. Experience: Minimum of 2 years of experience in Physician Advisory and Utilization Management.

Created: 2024-11-25