Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Shift:

Address:

City:

State:

Postal Code:

Job Description:

• Reviews and authorizes inpatient days, evaluates utilization patterns, and ensures appropriate inpatient/outpatient determinations.

• Works closely with Utilization Management staff on process improvement, case reviews, and continuity of care efforts.

• Serves as a clinical liaison with attending physicians and medical staff to support decision-making and accurate documentation.

• Collaborates with managed care payers and their medical directors on denials, appeals, and utilization criteria.

• Analyzes data and trends to identify utilization improvement opportunities, develop benchmarking, and monitor outliers.

• Provides education to physicians and clinical teams on UM protocols, regulatory changes, and documentation requirements.

• Reviews concurrent and post-acute payer denials, intervenes with providers and payers, and supports denial prevention strategies.

• Participates in Utilization Management and hospital committees, sharing trends and supporting quality and operational initiatives.

• Supports organizational goals related to length of stay, quality, responsible resource stewardship, and overall performance.

• Performs other duties as assigned.

Knowledge, Skills, and Abilities:

• Strong ability to build and sustain relationships in the medical community and a corporate environment [Required]

• Successful history as a practicing physician [Required]

• Strong organization skills with attention to detail [Required]

• Excellent analytical and problem-solving skills [Required]

• Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff [Required]

• Ability to work in a matrix-management environment to achieve organizational goals [Required]

• Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike [Required]

• Ability to provide expert medical advice and explain complex medical situation [Required]

• Health plan experience in operations [Preferred]

• Experience in a physician group model, leadership experience [Preferred]

• Effective computer skills, particularly Microsoft Office Outlook, Word, Excel, PowerPoint [Preferred]

Education:

• Doctorate [Required]

• Master's [Preferred]

Field of Study:

• Graduate of an accredited Medical School

• in Business or Healthcare Administration

Work Experience:

• 5+ years recent clinical practice experience [Required]

• 2+ years or greater experience as a Physician Advisor [Preferred]

• 3+ years of leadership experience [Preferred]

Additional Information:

• N/A

Licenses and Certifications:

• Medical Doctor (MD) [Required] OR Doctor of Osteopathic Medicine (DO) [Required]

• Basic Life Support (BLS) [Preferred]

Physical Requirements: (Please click the link below to view work requirements)

• Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.