HCA, Hospital Corporation of America Senior Manager Information Technology in Foster City, California
The HCA Physician Services Group (PSG) is the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 750 practices, Urgent Care Facilities, and partners with HCA’s 165 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career .
The Medical Director has the responsibility that the highest possible quality of medical services are provided by contracted network physicians as well as by other contracted network providers functioning under capitated, shared and full risk managed care contracts.
DUTIES AND ESSENTIAL JOB FUNCTIONS
Provide professional medical direction services to PPMSI including, but not limited to, implementing, maintaining and refining approved quality improvement and utilization management programs; keep up to date with and ensure compliance with federal regulation and NQCA requirements.
Help identify the data requirements of the directors, departments, and committees, across the PPMSI.
Help to coordinate the advancement of information systems to satisfy departmental data requirements.
Review medical informatics trends, experience and approaches, develops technical and application implementation strategies and assists in the development of strategic plans for information systems.
Participate in the review and assessment, and provide advice on complex, controversial and /or unique claims, which are outside the sphere of medical policy; solicit and evaluate advice of outside medical consultants and physicians with respect to complex or controversial claims or experimental and innovative techniques.
Provide medical expertise with respect to planning and establishing goals and policies to improve medical management and patient care.
Coordinate and communicate peer review information and decisions to network physicians.
Directly communicate with primary care physicians and other referring physicians in order to resolve referral issues, research treatment protocols, solicit advice on problem cases, and to assist in development of referral criteria and practice guidelines.
Support, communicate, and collaborate with case managers to resolve case management and referral issues.
Perform individual clinical case review, including grievances and appeals, and make corrective acting recommendations internally and externally when problems are identified.
Evaluate clinical studies and participate in the development of corrective action plans.
Analyze UM data and establish priorities for focused studies (high volume, high risk and high cost areas).
Identify utilization management and quality management studies and evaluate adverse trends in hospital utilization, unusual provider practice patterns, and comparative differences in utilization trends.
Contribute to development; review and dissemination of clinical studies and practice guidelines/standards.
Ongoing review of clinical indicators of ambulatory and inpatient care.
Serves as liaison to participating medical groups and network providers.
May attend contracted provider operations meetings as needed.
Participate in the annual review and development of the UM and QI programs, annual work plans, Credentialing Program and evaluation of each program’s effectiveness.
Review medical necessity denials and obtain specialist physician review for questionable or difficult cases. Specialist physician consultants from appropriate specialty areas of medicine and surgery and are certified by the American Boards of Medical Specialties are used as appropriate in this review process.
Contribute to development, review and dissemination of utilization review decision criteria to participating providers.
Work with physicians to develop strategies, which will ensure overall improvement of network performance and financial stability.
OTHER FUNCTIONS AND RESPONSIBILITIES Perform other duties as assigned and act as primary coverage to the Medical Director of Technology.
A minimum of 5 years of clinical experience along with 3 to 5 years of medical management experience and thorough knowledge of managed care and IPA functions.
Able to demonstrate strong knowledge of the regulatory environment of managed care.
Excellent clinical and analytical skills.
Clinical Instructor or Preceptor with the ability of communicating scientific and medical information to various audiences.
Familiarity with P4P, HCC coding, and disease management along with a strong comfort level with PC and HIT
Process-oriented, evidence-and scientifically inclined.
Knowledge of ambulatory utilization management, concurrent review, case management, quality management, and experience in methodologies of measuring such indicators is preferred.
Able to analyze quantitative and qualitative information and present it in a non judgmental or threatening fashion.
Possess excellent verbal and written communication skills with the ability to interact effectively at all levels of the organization in a variety of situations.
Work effectively with IPA Board, committees, physicians, providers of care, and management.
Maintain personal and professional values consistent with those of the organization and proactively support its mission and goals.
Able to quickly gain trust and establish credibility with physicians, other providers and management.
Possess a strategic vision of healthcare in the community setting and is capable of providing a system perspective.
Employ a participative, collaborative, management style, is an effective team builder, possess excellent problem-solving skills, and is able to identify and adapt to shifting priorities.
Board Certification in a recognized ABMS with appropriate residency training and a valid California license to practice medicine without restrictions.
Possess keen insight, is politically astute, and understands the perspective of other while developing consensus.
Training or experience in TQM/CQI preferred.
Consistent, enjoys being part of a team, thoughtful and has a thirst for continuous educations and development.
Additional academic and/or business degrees
Title: Senior Manager Information Technology
Location: California-Foster City-PPMSI
Requisition ID: 24614-51193