Medical Director WFH

HCA Healthcare; Nashville (TN); Remote; USD 200,000 - 300,000; Full time

Job summary

Join a forward-thinking healthcare provider as a Medical Director WFH, where you will lead clinical initiatives and drive excellence in patient care. This role emphasizes collaboration with hospitals and payers to enhance care quality while reducing denials. With a focus on leadership and communication, you'll mentor physicians and participate in strategic decision-making. Enjoy a comprehensive benefits package and the opportunity to make a significant impact in a dynamic environment. If you're ready to unlock your leadership potential, apply now and be part of a team that values excellence and innovation.

Benefits

Medical Coverage

401(k) Plan with Match

Employee Stock Purchase Plan

Educational Support

Free Counseling Services

Discounts through Abenity

Fertility and Adoption Assistance

Legal Counseling

Moving Assistance

Pet Insurance

Qualifications

• Licensed Physician (MD/DO) in the U.S. with Board Certification preferred.
• Minimum 5 years of clinical practice experience required.

Responsibilities

• Conduct peer-to-peer reviews with health plan counterparts for denied inpatient cases.
• Act as a liaison with payers to facilitate approvals and reduce denials.

Skills

Clinical Practice

Leadership

Communication

Utilization Review

Payer Liaison

Education

MD/DO License

Board Certification

5+ years of clinical experience

Tools

Microsoft Office Suite

InterQual

Milliman

Job description

Description

This position is incentive eligible.

Introduction

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 across 21 states and the United Kingdom. We are seeking a Medical Director WFH for our Work from Home team, where excellence fosters excellence.

Benefits

Enjoy a comprehensive total rewards package supporting health, life, career, and retirement. Benefits include:

• Medical coverage with many services at no cost or low copay, including prescription drugs, behavioral health, free telemedicine, and AirMed transportation.
• Additional options for dental, vision, life, disability, flexible spending accounts, supplemental health plans, auto and home insurance, identity theft, legal counseling, long-term care, moving assistance, pet insurance, and more.
• Free counseling services for emotional, physical, and financial wellbeing.
• 401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock.
• Family support including fertility, family building benefits with Progyny, and adoption assistance.
• Referral services for child, elder, and pet care, home and auto repair, event planning, etc.
• Discounts through Abenity and other providers.
• Retirement planning, rollover assistance, and banking partnerships.
• Educational support such as tuition, student loans, certifications, and scholarships.
• Recognition programs, time-off policies, and employee health assistance funds.

Learn more about Employee Benefits

Note: Benefits eligibility may vary by location.

HCA Healthcare has invested $3.5 billion in recent years to expand our influence. Want to be an industry influencer? Apply now for our Medical Director WFH role!

Job Summary and Qualifications

The Medical Director serves as a clinical resource and consultant to hospitals, focusing on denial identification, facilitation, and resolution. Responsibilities include timely peer reviews, documentation, and physician education on admission status, level of care, and comorbidities.

ESSENTIAL JOB RESPONSIBILITIES:

• Conduct peer-to-peer reviews with health plan counterparts for denied inpatient cases.
• Act as a liaison with payers to facilitate approvals and reduce denials; mentor physicians on payer requirements.
• Analyze utilization review metrics; collaborate with hospital committees to develop and monitor denial reduction strategies.
• Provide input on managed care contracting, process improvements, and denial prevention initiatives.
• Demonstrate leadership, collaboration, and effective communication.
• Participate in appeal processes; oversee pre-bill denial strategies; coordinate with payer medical directors; educate physicians on ICD coding and clinical terminology to improve documentation and DRG accuracy.

REPORTS TO: VP Physician Advisor Peer to Peer Services

POSITION QUALIFICATIONS:

• Licensed (or eligible) Physician (MD/DO) in the U.S.
• Board Certification (Internal Medicine and Family Medicine preferred); ABQAURP certification preferred.
• HCQM Board Certification preferred.
• Experience with payors or as a physician advisor is a plus.

EDUCATION AND EXPERIENCE:

• Minimum 5 years of clinical practice experience.
• Knowledge of InterQual, Milliman, or similar criteria.
• Familiarity with Joint Commission, state and federal standards, and reimbursement models.
• Understanding of medical necessity criteria for third-party payers.
• Organized with strong deadline management skills.
• Proficient in Microsoft Office Suite.

"Bricks and mortar do not make a hospital. People do."
- Dr. Thomas Frist, Sr., HCA Healthcare Co-Founder

If you seek a leadership role with personal and professional growth, apply now to join HCA Healthcare as a Medical Director WFH. Unlock your leadership potential with us.

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

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