Schedule: Full time
Shift: Day (United States of America)
Address: 2000 FOWLER GROVE BLVD
City: WINTER GARDEN
State: Florida
Postal Code: 34787
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: 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:$208,665.60 - $417,352.00
