Medical Director
Not Disclosed•Full-TimeRemote
location_on303, North Main Street, Nashville, Howard County, Arkansas, 71852, United States
About the Team
HCA Healthcare is one of the nation's leading providers of healthcare services, comprising over 180 hospitals and approximately 2,000 sites of care across 21 states and the United Kingdom. We are recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare has invested $3.5 billion in capital improvements and spent an estimated $3.7 billion on charitable care, uninsured discounts, and other uncompensated expenses.
Parallon, the division supporting this role, provides full-service revenue cycle management for HCA Healthcare and external clients. With over 17,000 colleagues, Parallon serves close to 1,000 hospitals and 3,000 physician practices, making a significant impact on patients, providers, and their communities.
About the Role
Executives thrive with us! We are looking for a Medical Director for our Work from Home team where excellence creates excellence. In this role, you will serve as a clinical resource and consultant to hospitals, focusing on the identification, facilitation, and resolution of denials. You will act as a liaison with payers to facilitate approvals and prevent denials, while also mentoring and educating other physicians regarding payer requirements.
Your day-to-day will involve conducting peer-to-peer reviews with health plan counterparts for denied inpatient cases and participating in concurrent and retrospective appeal peer-review processes. You will perform data analysis related to utilization review metrics and collaborate with hospital utilization management committees to develop action plans for denial reduction. Additionally, you will educate physicians on ICD coding guidelines, clinical terminology, and the nuances of severity, acuity, and DRG assignments to improve the accuracy of patient records.
Hiring Process
This position is incentive eligible. To join our team, please apply for the Medical Director role today. Eligibility for benefits may vary by location.
Equal Opportunity
HCA Healthcare is committed to fostering a diverse and inclusive environment. We are an equal opportunity employer and consider qualified applicants regardless of background.
Work location
Work model: Remote
303, North Main Street, Nashville, Howard County, Arkansas, 71852, United States
Nashville, Arkansas
Key Responsibilities
- check_circleAct as a liaison with payers to facilitate approvals and prevent denials
- check_circlePerform data analysis on utilization review metrics to develop denial reduction plans
- check_circleProvide physician education on ICD coding guidelines and clinical terminology
- check_circleSchedule and manage meetings with payer medical directors for collaboration
- check_circleParticipate in concurrent and retrospective appeal peer-review processes
- check_circleOffer oversight to pre-bill denial strategies within the payer process
- check_circleConduct peer-to-peer reviews with health plan counterparts for denied inpatient cases
Requirements
- verifiedLicensed (or eligible for licensure) Physician (MD/DO) in a state in the United States
- verifiedBoard Certification Required (Internal Medicine and Family Medicine preferred)
- verifiedMinimum of 5 years of experience in clinical practice
- verifiedKnowledge of InterQual, Milliman or related evidenced based criteria sets
- verifiedFamiliar with Joint Commission, State and Federal standards/requirements, and DRG vs Per diem reimbursement models
- verifiedKnowledgeable about third party payer source criteria of medical necessity
- verifiedComputer experience required with skills including but not limited to Microsoft Windows, spreadsheets, and word processing
Nice to Have
Board Certification in Internal Medicine and Family Medicine. Preferred work experience as a physician advisor.
Benefits & Perks
check_circleComprehensive medical coverage with prescription drug, behavioral health, free telemedicine, and free AirMed transportationcheck_circleDental and vision benefits, life and disability coverage, flexible spending accounts, and supplemental health protection planscheck_circle401(k) Plan with 100% match on 3% to 9% of pay based on years of serviceEmployee Stock Purchase Plan with 10% discount on HCA Healthcare stock
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Frequently asked questions about Medical Director at HCA Healthcare
What does a Medical Director at HCA Healthcare do?expand_more
A Medical Director at HCA Healthcare is responsible for the following: Act as a liaison with payers to facilitate approvals and prevent denials; Perform data analysis on utilization review metrics to develop denial reduction plans; Provide physician education on ICD coding guidelines and clinical terminology; and Schedule and manage meetings with payer medical directors for collaboration.
What are the requirements for this Medical Director role?expand_more
To qualify for the Medical Director at HCA Healthcare position, applicants should have: Licensed (or eligible for licensure) Physician (MD/DO) in a state in the United States; Board Certification Required (Internal Medicine and Family Medicine preferred); 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, and DRG vs Per diem reimbursement models; and Knowledgeable about third party payer source criteria of medical necessity.
Where is the Medical Director role at HCA Healthcare located?expand_more
Medical Director at HCA Healthcare is based in 303, North Main Street, Nashville, Howard County, Arkansas, 71852, United States. This is a remote role.
Is this Medical Director job remote, hybrid, or on-site?expand_more
HCA Healthcare has listed this Medical Director role as remote.
How much experience is required for this Medical Director role?expand_more
Medical Director at HCA Healthcare typically requires 5+ years of relevant experience at the executive level.
What skills do you need for the Medical Director role at HCA Healthcare?expand_more
Key skills for Medical Director at HCA Healthcare include Interqual; Milliman; Icd Coding; DRG; Microsoft Windows; Spreadsheets; and Word Processing.
What category does the Medical Director role belong to?expand_more
Medical Director at HCA Healthcare is part of the healthcare & nursing job category on Recrutus.