Administrative/CEO Physician

The Physician Advisor works collaboratively with case managers, social workers, and admitting physicians to ensure patients are placed at the correct level of care and that medical necessity is well-documented. The PA also addresses issues around clinical documentation, billing compliance (including CMS 2-Midnight Rule), length of stay, readmissions, and quality metrics. This position reports through a matrix structure to the Corporate Physician Advisor, Chief Quality and Integration Officer (CQIO), and entity-level CMO/CEO.

Key Responsibilities:

• Provide real-time clinical guidance to ensure appropriate level of care and utilization
  

• Support accurate clinical documentation to reflect severity of illness and medical necessity
  

• Collaborate with providers and hospital staff to improve care transitions and reduce LOS/readmissions
  

• Conduct post-discharge audits and respond to payer reviews or appeals
  

• Educate medical staff on CMS regulations, InterQual/MCG criteria, and billing requirements
  

• Drive clinical practice improvements that enhance patient care and hospital performance
  

• Promote interdepartmental collaboration and communication through education and support
  

• Maintain knowledge of current compliance standards and payer guidelines through ongoing education
  

Qualifications:

• MD or DO degree from an accredited institution
  

• Active medical license in Florida
  

• Minimum 3 years of clinical practice experience
  

• Experience with medical necessity reviews and use of MCG or InterQual criteria
  

• Knowledge of CMS Conditions of Participation, billing regulations, and the 2-Midnight Rule
  

• Strong communication, organization, and critical thinking skills
  

Certifications:

• Board Certification by ABQAURP (or equivalent) required within 1 year of hire
  

• Physician Advisor Certification preferred at time of hire
  

Additional Skills:

• Ability to manage multiple deadlines and shifting priorities
  

• Proficiency in relevant technology and EMR systems
  

• Ability to lead and educate in both individual and group settings
  

• Demonstrated professionalism and sound clinical judgment