Pediatrician -Medical Director
Pediatrician -Medical Director
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Job Description
Job Description
Job Summary
The Spectrum Healthcare ResourcesMedical Director oversees and chairs/participates in committees (e.g. quality management/improvement) as assigned for T5/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 systembased 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 highquality 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 peertopeer 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: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 Militaryand VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities VA clinicsand other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm SHR isthe military staffing division of TeamHealth a Nationwide organizationthat serves 860 civilian and military hospitals with a team of 9800 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.
Location : Location
Recruiter : Full Name: First Last
Direct phone number
Recruiter : Email
Required Experience:
Director
Employment Type
Unclear
