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Description

Introduction

Do you have the career opportunities as a VP Clinical Review you want with your current employer? We have an exciting opportunity for you to join Parallon which is part of the nation's leading provider of healthcare services, HCA Healthcare.

Benefits

Parallon, 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 (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

_Note: Eligibility for benefits may vary by location._

Our teams are a committed, caring group of colleagues. Do you want to work as a VP Clinical Review 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 and Qualifications

Parallon has an exciting opportunity for a professional to join the corporate team as the Vice President of Clinical Review. The primary role of the VP of Clinical Review will be focused on a series of executive leadership, management and operational tasks. This role will include key responsibilities around physician review of appeal letters, physician advisor coaching, post appeal peer to peers, quality assurance projects and payor relations. The VP may also serve as a clinical expert witness for unresolved cases being pursued via litigation, mediation or arbitration. The VP will also focus on continuing education by intervening when practice patterns, behaviors or documentation issues create disparity between pathway standards, intensity of service, severity of illness or other issues.

What you will do in this role:

+ Assists with status, level of care and length of stay dispute resolution. This will include assessment of inpatient vs. outpatient observation status, compliance with two-midnight rule within the Parallon process, and transition of care issues.

+ Responds in a timely manner to requests to intervene with payers, denials and appeals processes, observation level of care, decisions regarding admission and the transition of patients, termination of benefits notification, and other situations as requested or as discovered.

+ Identifies payer medical policies with narrow application of acceptable standards causing inappropriate denials and generates discussions with payer medical directors to challenge application.

+ Serves as an expert witness or consultant in cases escalated via legal proceedings to include litigation, mediation or arbitration proceedings.

+ Analyses and monitors physician documentation to identify areas where improvement is needed.

+ Leads clinical appeal staff process improvement initiatives and assists in formulating best practices and standards in clinical appeals process.

+ Assists clinical appeal staff in highlighting appropriate and accurate clinical documentation in appeals to substantiate medical necessity for services provided

+ Serves as a leader in coordinating ongoing educational programs that will serve to strengthen the clinical appeal and peer to peer processes.

+ Brings matters of potential or actual problems in physician practices or documentation to the attention of CMO/VP of Physician Advisory Services.

+ Assists with onboarding of new physician advisors and coaching of lower performing physician advisors.

+ Leads and manages the quality assurance team and give feedback to the senior medical directors regularly.

+ Performs yearly IQ and MCG competency evaluations on the physician advisors.

+ Meets with payors, URS or appeal teams per discretion of the CMO/VP of physician advisory services.

+ Functions as a part of the executive management team and participate in leadership meetings as needed.

+ Keeps up with payor policy updates and communicates the changes with the leadership team.

What qualifications you will need:

+ MD/DO with board certification and active unrestricted license in one state at minimum.

+ 5 years of leadership preferred.

+ Minimum 8-10 years of clinical experience.

+ MBA preferred.

**Parallon (https://parallon.com/)** provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s 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 VP Clinical Review 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.