Introduction

Managers thrive with us! HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising of over 180 hospitals and about 2,000 sites of care in 21 states and the United Kingdom. We are looking for a Division Denial Manager for our Tristar Health team where excellence creates excellence.

Benefits

Tristar Health, 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.

HCA Healthcare has expanded our influence across the healthcare industry by investing $3.5 billion in capital improvements in recent years. Do you want to be an influencer in healthcare? Apply for our Division Denial Manager role today!

Job Summary and Qualifications

The Division Denial Manager reports to the Division Case Management Director and provides leadership in developing and executing strategic initiatives relating to denial resolution. This role requires a complete understanding of Case Management and Utilization Management functions as they relate to denials. The Division Director of Denial Management is responsible for the development of standard processes and ensures that all initiatives meet HCA and regulatory requirements.

What you will do in this role:

• You will demonstrate knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives.
• You will monitor self-compliance and implement process changes to ensure compliance to such regulations as it relates to the denial management.
• You will demonstrate ability to use data analysis to lead process improvement and standardization of workflow related to the denial management across the TriStar Division.
• Your role assumes accountability for promoting consistent, positive patient interactions that advance the agenda of unparalleled patient service.
• You will maintain a patient-first philosophy and engages in service recovery when necessary.
• Your role supports the development and implementation of strategies to elevate the patient experience.
• This role requires you to have the ability to communicate and collaborate between facility staff on all levels and other departments within HCA to minimize financial risk related to denial management.
• You will provide denial management training to new facility Directors of Case Management.
• Your role identifies educational opportunities with the facilities and assists with accurate and timely communication required for intervention.
• You will possess the ability to present to senior team leaders at the hospital and Division level as requested with involvement in measurement outcome.
• You will demonstrate the ability to work with the Division Case Management Director to initiate change to meet the TriStar Division and Corporate goals in the area of denial reduction.
• As the Division Director of Denial Management, you will work with division payer contracting to foster meeting with payer groups for the purpose of process clarification.
• You will practice and adhere to the “Code of Conduct” and “Mission and Value Statement.”

What qualifications you will need:

• Bachelors of Science in nursing preferred or equivalent work experience relevant to the position
• Minimum 5 years of hospital experience; preferably, RN Case Management experience in acute care
• Denial Management and work with payer experience preferred
• Strong knowledge of Utilization Review and Medical Necessity preferred
• InterQual Certified instructor preferred

• Must have excellent leadership, communication, customer service and strong data analysis skills

HCA Healthcare has been named one of the World’s Most Ethical Companies by Ethisphere Institute for ten consecutive years (2010-2019). In 2019, 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're looking for a leadership opportunity that provides both personal satisfaction and professional growth, apply to join HCA Healthcare as a Division Denial Manager.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.