Physician Advisor Medical Director

HCA Healthcare Physician Advisor Medical Director Nashville, Tennessee Apply Now

Executives thrive with us! HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising over 180 hospitals and about 2,000 sites of care in 21 states and the United Kingdom. We are looking for a Medical Director for our Work from Home team where excellence creates excellence.

The Medical Director serves as a clinical resource and consultant to hospitals by providing identification, facilitation, and resolution of denials. The Medical Director will be responsible for timely completion of assigned peer to peers and documentation of the outcomes. The Medical Director will also provide physician education regarding accurate determination and documentation of the admission status/level of care and presence of complications or comorbidities.

What you will do in this role

1. Conduct peer to peers with health plan counterpart for denied inpatient cases. Act as a liaison with payers to facilitate approvals and prevent any denials. Facilitate, mentor, and educate other physicians regarding payer requirements.
2. Perform data analysis related to utilization review (UR) metrics, work with hospital utilization management committees upon request to develop, implement, and monitor action plans related to denial reduction and authorization of level of care.
3. Offer input on managed care contracting issues, best demonstrated practices, process improvement and utilization management activities, barriers to achieving goals and objectives of initiatives, and denials prevention initiatives.
4. Demonstrate leadership, collaboration, and effective communication skills.
5. Participate in the concurrent and retrospective appeal peer-review process.
6. Provide oversight to the pre bill denial strategy within the payer process.
7. Schedule and manage meetings with payer medical directors for collaboration and process improvement. Function as a core team member of the denial management team.
8. Educate 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:

1. Licensed (or eligible for licensure) Physician (MD/DO) in a state in the United States.
2. Board Certification Required (Internal Medicine and Family Medicine preferred) Preferred ABQAURP HCQM Board Certification.
3. Preferred work experience with the payors or as a physician advisor.
4. Minimum of 5 years of experience in clinical practice.
5. Knowledge of InterQual, Milliman or related evidenced based criteria sets.
6. Familiar with Joint Commission, State and Federal standards/requirements, and DRG vs Perdiem reimbursement models.
7. Knowledgeable about third party payer source criteria of medical necessity.
8. Organized and able to meet deadlines consistently.
9. Computer experience required with skills including but not limited to Microsoft Windows, spreadsheets, and word processing.

If you're looking for a leadership opportunity that provides both personal satisfaction and professional growth, apply to join HCA Healthcare as a Medical Director. Unlock your leadership potential with HCA Healthcare.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.