Medical Director
Medical Director
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
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
Required Experience:
Director
Employment Type
Full-Time
