Pediatrics Physician

Spectrum Healthcare Resources; Seattle (WA); Remote; USD 200,000 - 250,000; Full time

Job summary

Spectrum Healthcare Resources is seeking a Medical Director to oversee quality management and collaborate with medical management staff. This primarily remote role requires a Medical Doctor degree and extensive experience in clinical practice and medical management.

Qualifications

• 5+ years clinical practice experience.
• 3+ years medical management experience in Managed Care.

Responsibilities

• Oversees clinical staff reviewing potential quality issues.
• Provides program guidance and clinical expertise for Medical Management programs.
• Collaborates with TriWest staff on issues and programs.

Skills

Clinical Quality Management

Utilization Management

Peer Reviews

Data Analytics

Education

Medical Doctor Degree

Board Eligible or Board Certified in Pediatrics

Job description

Job Summary
The Spectrum Healthcare Resources Medical Director oversees and participates in committees (e.g., quality management/improvement) 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 reviews, and provider interactions (peer-to-peer). Oversees clinical staff reviewing potential quality issues and appropriateness of care, developing 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 ensure timely, appropriate, and high-quality care. Utilizes data with Data Analytics and other TriWest staff to facilitate and optimize healthcare delivery. Interacts directly with beneficiaries to ensure high satisfaction levels. Maintains board certification and state licensure in required states. Occasional travel and meetings are required. Position is primarily remote.

Education & Experience

Required

• Medical Doctor Degree
• U.S. Citizenship
• Ability to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation for public trust
• Current unrestricted medical license in a U.S. state or territory (California and Washington preferred); open to obtaining additional licenses
• Board Eligible or Board Certified in Pediatrics
• 5+ years clinical practice experience
• 3+ years medical management experience in Managed Care

Preferred

• Advanced degree in public health or business
• Experience with government healthcare (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 meetings
• Provides clinical expertise to staff as needed
• Possesses knowledge of medical practice standards; conducts research on new technologies and treatments as needed
• Collaborates with TriWest staff on issues and programs, including General Counsel, Data Analytics, Communications, and Executive Leadership

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), established in 1988, delivers systems and processes tailored to Military and VA Health Systems. SHR provides physician and clinical staffing and management services to U.S. Military Treatment Facilities, VA clinics, and other Federal Agencies through various contracts. A Joint Commission-accredited Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, serving 860 civilian and military hospitals with 9,800 healthcare professionals.

Spectrum Healthcare Resources is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, veteran status, or other protected characteristics.