Job Description

Job Summary
The Spectrum Healthcare ResourcesMedical Director oversees and chairs/participates in committees (e.g. quality management/improvement), as assigned, for T-5/DoD and CCN/VA. Works closely with medical management staff (Clinical Quality Management, Utilization Management, Case Management, Referral Management, Disease Management, Public Health, Clinical Operations, and Clinical Systems) to accomplish Medical Management tasks including clinical quality reviews, peer review, and provider interactions (peer to peer.) Works closely with and oversees clinical staff reviewing potential quality issues and appropriateness of care. Develops provider and system-based corrective action plans as needed. Documents reviews of clinical quality and appropriateness of care in CareRadius and other IT systems. Collaborates with VA, network providers, and TriWest staff to assure timely, appropriate, and high-quality care. Uses data to facilitate and optimize the delivery of health care services, in collaboration with Data Analytics and other TriWest staff. Interacts directly with beneficiaries, as indicated, to assure a high level of satisfaction. Obtains and maintains board certification and state licensure in the required states. Occasionally travels and attends meetings, as required. Position is primarily remote work.

Education & Experience

Required
• Medical Doctor Degree
• U.S. Citizenship

• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation for public trust

• Current unrestricted license to practice medicine in a state or territory of the United States - California and Washington prefered - must be open to potentially obtaining more licenses as needed

• Board Eligible or preferably Board Certified in Pediatrics
• 5+ years clinical practice experience

• 3+ years medical management experience in a Managed Care environment • Experience with utilization Management, Quality Management, Case Management, and/or Disease Management

Preferred
• Advanced degree in public health or business
• Government Healthcare experience (e.g. Tricare, Veterans Affairs)
• 2+ years managed care experience

Key Responsibilities
• Provides program guidance and clinical expertise for Medical Management programs

• Engages in peer-to-peer discussions with network providers and others, as needed

• Reviews potential quality issues for corrective action

• Reviews member cases for appropriateness of care

• Participates in internal, external, and joint quality and safety meeting

• Provides clinical expertise to staff, as needed

• Possesses knowledge of medical practice standards and conducts research, as needed, on new technologies and treatments
• Collaborates with TriWest staff on issues and programs, including General Counsel, Data Analytics, Communications, Executive Leadership Team, and others, as needed

Contact:

Joseph Day
Senior Recruiter

Spectrum Healthcare Resources
12647 Olive Blvd Suite 600 St. Louis, MO 63141
Toll Free: 1- ext. 54138

Direct:

Company Overview:

Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 860 civilian and military hospitals with a team of 9,800 affiliated health care professionals.

Spectrum Healthcare Resources is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

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