Description
Introduction
Do you have the career opportunities as a Quality Control Senior Manager you want with your current employer? We have an exciting opportunity for you to join HCA Healthcare which is part of the nations leading provider of healthcare services, HCA Healthcare.
Benefits
HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
- Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
- Free counseling services and resources 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 through fertility and family building benefits with Progyny and adoption assistance.
- Referral services for child, elder and pet care, home and auto repair, event planning and more
- Consumer discounts through Abenity and Consumer Discounts
- Retirement readiness, rollover assistance services and preferred banking partnerships
- Education assistance (tuition, student loan, certification support, dependent scholarships)
- Colleague recognition program
- Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
- Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
Our teams are a committed, caring group of colleagues. Do you want to work as a Quality Control Senior Manager where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!
Job Summary
We are seeking a diligent and experienced Senior Manager, Clinical Review, Quality Control to ensure the quality and accuracy of clinical reviews. This role is pivotal in identifying and addressing payer medical policy issues, supporting the regulatory compliance team, and enhancing the overall quality of our clinical processes. The Senior Manager will analyze physician documentation, assist with quality control and oversight, and serve as a subject matter expert for educational programs. This position also involves active participation in leadership meetings and contributing to the onboarding of new physician advisors.
Major Responsibility
- Perform rigorous quality control on clinical reviews, focusing on patient status, level of care, and length of stay to ensure accuracy and compliance.
- Proactively identify and address payer medical policies that lead to inappropriate denials, advocating for fair and accurate coverage.
- Provide crucial support to the regulatory compliance team in managing appeals and improving documentation to meet regulatory standards.
- Serve as a subject matter expert, guiding clinical appeal and peer-to-peer processes with expertise and insight.
- Actively participate in leadership meetings, contributing to strategic decision-making, and assist in the onboarding of new physician advisors, ensuring they are well-prepared for their roles.
- Conduct thorough quality control on accounts that have been reviewed, specifically focusing on patient status, level of care, and resolution of length of stay disputes. This includes assessing inpatient vs. outpatient observation status and ensuring compliance with the two-midnight rule.
- Respond promptly to requests for intervention from the centralized peer-to-peer team and others regarding denials and appeals processes, observation level of care, decisions about admission, patient transitions, and other situations as needed.
- Analyze and monitor physician documentation to pinpoint areas needing improvement, ensuring comprehensive and accurate records.
- Support regulatory team members by highlighting accurate clinical documentation in appeals to substantiate the medical necessity of provided services.
- Serve as a subject matter expert, coordinating ongoing educational programs to strengthen clinical appeal and peer-to-peer processes.
- Bring potential or actual problems in physician practices or documentation to the attention of regulatory leadership, ensuring timely and effective resolution.
- Assist with the onboarding of new physician advisors, providing guidance and support to ensure their success.
- Function as a key member of the executive management team, participating in leadership meetings and contributing to strategic initiatives.
Education & Experience
- A minimum of 8-10 years of clinical experience is required.
- At least 2 years of leadership experience is preferred.
- Possess a strong clinical background, with preference given to candidates familiar with Medicare and Medicare Advantages Two-Midnight Rule.
Licenses, Certifications & Training:
- MD/DO preferred, particularly those no longer directly involved in patient care.
We are comprised of affiliated hospitals, physician practices and other sites of care across the United States and United Kingdom. The Sarah Cannon Cancer Network is transforming cancer care through integrated services and cutting-edge technologies. Our physicians can develop leading oncology programs to advance science and patient care. Providing physician-led patient care offers our doctors access to a national network of experts. This is where multidisciplinary teams come together with a goal of delivering seamlessly coordinated, quality cancer care. Through a united network of globally recognized oncology specialists, we collaborate and share best practices. We address each aspect of the cancer journey, from screening and diagnosis through treatment and survivorship, to advance our shared mission: Above all else, we are committed to the care and improvement of human life.
HCA Healthcare has been recognized as one of the Worlds Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Quality Control Senior Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
