Remote Utilization Review Jobs in Florida (NOW HIRING)

Department: Jackson Memorial Hospital Administration
Address: 1611 NW 12 Avenue, Miami, FL 33136 (Remote and/or Hybrid)
Hours: Variable days including weekends (Per Diem)
Why Jackson:
Jackson Health System is a nationally and internationally recognized academic medical system offering world-class care to any person who walks through our doors. For more than 100 years, Jackson has evolved into one of the world's top medical providers for all levels of care, no matter if it's for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for the University of Miami Miller School of Medicine. Here, the best people come together to deliver Jackson's mission for our diverse communities. Our employees are committed to providing the best CARE by demonstrating compassion, accountability, respect, and expertise in everything we do.
Position Summary:
• The Physician Advisor (PA) serves as a clinical resource to the medical staff and Case Management/Social Work by providing identification, facilitation and resolution of utilization issues.
• The PA role reports to the CMO, CUO or his/her designee.
• The Physician Advisor addresses the following issues: level of care, Payer peer to peer correspondence, documentation, compliance, discharge planning, and hospital reimbursement and quality issues.
• Additionally, the Physician Advisor role ensures proper ensures proper status determination with support for CM/SW (case manager/social worker).
• Additionally, Physician Advisors promote understanding and cooperation between the medical staff through communication, collaboration and education.
Duties & Responsibilities:
• Acute Inpatient/Care Management Functions: Physician Advisors are expected to round on their designated units daily and be the bridge with the various medical teams and physicians to ensure appropriate utilization, and improved documentation.
• Participates in review of long stay patients to facilitate the use of the most appropriate level of care and to reduce readmissions. Provides feedback to attending and consulting physicians regarding level of care, length of stay, quality issues. Assists physicians with end of life care planning when appropriate.
• Documents response to case management referrals. Communicates with payors to justify admissions and overturn denials as appropriate, including peer to peer communication with payors.
• The Physician Advisor conducts clinical reviews on cases referred by care management staff and/or other health care professionals to help determine admission status, meet regulatory requirements and assure quality patient care and effective utilization of health care services.
• The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, use of resources and payor requirements. The Physician Advisor works with clinical teams to resolve delays related to consultations, imaging and procedures.
• Hospital Process Improvement: Promotes coordination, communication and collaboration among all team members. Actively engage with attending physicians and residents/fellows when concurrent or retrospective review identifies a documentation issue.
• Supports the organization in quality improvement efforts requiring physician input and/or involvement.
• Clinical Documentation Support: Acts as a liaison between the CDI professional, HIM, and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data. Educates hospital staff physicians about ICD coding guidelines and clinical Terminology.
Qualifications / Experience:
The ideal candidate has experience as a hospitalist, physician advisor, or experience with utilization review or CDI. Knowledge of, and experience with InterqQual, MCG, and major payor classes is desirable.
Education:
MD or DO degree (US or Foreign Medical Graduate) is required.
License Certification:
Active Florida medical license or house physician license (or eligibility) is required. ABQAURP certification is preferred.
Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.