HCA Healthcare

Medical Director

HCA Healthcare • $210K — $250K *
Nashville, TN 37211In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Licensed Physician (MD/DO) in the U.S.
  • Board Certification in Internal or Family Medicine preferred
  • Experience as a physician advisor is advantageous
  • At least 5 years of clinical practice experience
  • Familiarity with InterQual, Milliman, or similar criteria
  • Knowledge of Joint Commission and reimbursement models
  • Understanding of third-party payer criteria for medical necessity.
  • Proficient in Microsoft Windows, spreadsheets, and word processing.

Responsibilities

  • Conduct peer reviews with health plan counterparts on denied inpatient cases
  • Act as a liaison with payers to facilitate approvals and educate physicians
  • Analyze data related to utilization review metrics and develop action plans
  • Provide insights on managed care contracting and process improvements
  • Demonstrate leadership and effective communication skills in collaborations
  • Participate in the peer-review process for concurrent and retrospective appeals
  • Oversee the pre-bill denial strategy and manage payer meetings
  • Educate physicians on ICD coding guidelines and clinical terminology.

Benefits

  • Incentive eligibility.
Full Job Description
This position is incentive eligible.

Job Summary and Qualifications

TheMedical directorserves as a clinical resource and consultant to hospitals byproviding identification, facilitation, and resolution of denials. The Medical Director willberesponsiblefortimelycompletionof assignedpeertopeers and documentation of the outcomes. The Medical Directorwill also provide physician educationregardingaccuratedeterminationand documentation of theadmission status/level of care and presence of complications or comorbidities.

What you will do in this role

  • Conducts peer to peers with health plancounterpartfordenied inpatient cases.


  • Acts as a liaison with payers tofacilitateapprovalsand prevent any denials. Facilitates, mentors, and educates other physiciansregardingpayerrequirements.


  • Performs data analysis related toutilizationreview(UR) metrics, works with hospitalutilizationmanagementcommittees upon request to develop, implement, andmonitoractionplans related to denial reduction and authorization of level of care.


  • Offers input on managed care contracting issues, bestdemonstratedpractices, process improvement andutilizationmanagementactivities, barriers to achieving goals andobjectivesofinitiatives, anddenialspreventioninitiatives.


  • Demonstrates leadership, collaboration, and effective communication skills.


  • Participate in the concurrent and retrospectiveappealpeer-review process.


  • Provides oversighttothepre billdenialstrategy within the payer process.


  • Schedules and manages meetings with payer medical directors for collaboration and process improvement. Functions as a core team member of the denial management team.


  • Educates physicians about ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual patient records.


What Qualifications you will need:

  • Licensed (or eligible for licensure) Physician (MD/DO) in a state in the United States.


  • Board Certification Required (Internal Medicine and Family Medicine preferred)


  • Preferred work experienceas aaphysician advisor.


  • Minimum of 5 years of experience in clinical practice.


  • Knowledge of InterQual, Milliman or related evidenced based criteria sets.


  • Familiar with Joint Commission, State and Federal standards/requirements, andDRG vsPerdiemreimbursement models.


  • Knowledgeable aboutthird party payer source criteriaofmedicalnecessity.


  • Organized and able to meet deadlines consistently.


  • Computer experiencerequiredwithskills including but not limitedto MicrosoftWindows,spreadsheets, and word processing.


About HCA Healthcare

HCA Healthcare Careers

Join the dedicated team at HCA Healthcare, a leading provider in the medical field, and be part of a company known for its exceptional care and commitment to innovation. At HCA Healthcare, we offer a variety of job opportunities that allow professionals to grow their careers in a supportive and diverse environment.

Work You’ll Do

At HCA Healthcare, you will contribute to a culture that values patient care above all. Our team members are equipped with the skills and resources needed to provide outstanding healthcare services. With positions ranging from nursing to administrative roles, HCA Healthcare is actively hiring and offers a dynamic workplace where leadership and professional growth are encouraged.

Innovate and Lead

Join a team where innovation is at the heart of everything we do. HCA Healthcare is a place where you can lead efforts to improve patient outcomes using the latest technologies and practices in the healthcare industry. Our leadership is committed to fostering a culture of diversity and inclusion, ensuring all team members can thrive.

Professional Growth and Development

HCA Healthcare believes in nurturing the growth of its employees through robust professional development and training programs. Whether you are just starting your career or are a seasoned professional, we provide the tools and training necessary to advance your skills and take on new challenges. Explore our wide range of career paths and find the position that best suits your skills and passions.

Benefits and Culture

Our employees enjoy a range of benefits designed to support their physical, financial, and emotional well-being. From comprehensive health insurance to retirement plans and employee wellness programs, HCA Healthcare takes care of its team. Our inclusive culture and commitment to work-life balance make HCA Healthcare a desirable place to work.

Internship and Networking Opportunities

For those new to the healthcare field, HCA Healthcare offers internship programs that provide real-world experience and a pathway to full-time employment. Additionally, our extensive professional network allows for endless networking opportunities, helping you to build relationships and advance your career.

Join Our Team

Search open positions that match your skills and interests. We look for passionate, curious, creative, and solution-driven team players. Ready to start your journey with HCA Healthcare? Prepare your resume, sharpen your interview skills, and apply today to become part of a team that’s dedicated to improving lives.

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Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding career opportunities that await at HCA Healthcare. Explore the possibilities with HCA Healthcare, where your career is nurtured, and your contributions are valued. Join us in our mission to deliver high-quality patient care through innovative practices and a compassionate approach.
Learn more about HCA Healthcare
Size
204,000 employees
Market Cap
$67.9 billion
Industry
Healthcare
Net Income
$3.7 billion
Founded
1968
5 Year Trend
+7.2%
Revenue
$51.5 billion
NASDAQ
HCA
* Ladders Estimates

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