Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen, and military family members are encouraged to apply!
Job Summary
Provides leadership, direction and coordination for the Clinical aspects of TriWest’s support to Department of Veteran Affairs and Department of War including Medical Management. Oversees the coordination with medical management operations. Coordinates with other TriWest's divisions and clinical leadership to support MHS and VA contracts. Serves as clinical voice with MHS and VA peer level clinical subject matter experts and leaders. Chairs or Co-Chairs the TriWest internal and joint external committees. Oversees clinical quality and collaborates to meet contractual requirements.
Education & Experience
Required:
- MD or DO degree obtained from an institution accredited by the Liaison Committee on Medical Education and listed in Association of American Medical Colleges
- Board-certified by a recognized MD or DO specialty board
- Hold current unrestricted license to practice medicine
- U.S. Citizen
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
- TRICARE and MHS experience
- 10+ years of medical practice experience
- 7+ years of senior medical management experience
- 10+ years of diverse management experience
- Subject to a credentialing process to verify licensure, board certification, and standing with HHS and NPDB
Preferred:
- Familiarity with government, VA, and commercial healthcare systems
- Background in health care systems and customer service or equivalent experience
- 5+ years of managed care experience
Key Responsibilities
- Functions as a senior clinical leader, advisor, and liaison between TriWest and stakeholders.
- Leads and manages the medical/surgical medical director team to include recruiting and staffing, onboarding, workload management and performance management.
- Facilitates consultation on second level reviews and other medical management requirements.
- Collaborate with the Chief Medical Officer – Behavioral Health on common goals and issues.
- Oversees the quality assessment program and chairs (or Co-Chairs) the Quality Management and Improvement Committee and co-chairs joint quality committees with government lead.
- Coordinates in the analysis of overall TriWest Healthcare enterprise performance.
- Directs and oversees communications to leadership and staff to ensure a streamlined and consistent process for servicing shareholders, government partners, and customers.
- Functions as a principal leader in ensuring URAC compliance.
- Coordinates in the oversight of customer access to care and monitors network adequacy.
- Participates in the analysis of financial impact studies to manage and evaluate contract changes and health care costs.
- Oversees and assists in the development and negotiation of contracts.
- Ensures compliance with contract requirements.
Analyzes reports for and from shareholders, contract representatives, and TriWest senior leadership to define medical director operational activities, goals, and objectives.- Provides guidance for clinical operational aspects and is responsible for oversight of clinical decision-making aspects of the quality program.
- Ensures the organizational objective to have qualified clinicians accountable to the organization for decisions affecting consumers.
- Has periodic consultation with practitioners in the field.
- Analyzes, develops, and implements continuous quality improvement processes.
- Develops and maintains production standards ensuring quality control, timely and accurate management of workload.
- Functions as a senior clinical consultant to senior leadership and other TriWest divisions.
- Functions as principal clinical liaison with contracted entities.
- Coordinates and oversees programs, processes, and projects.
- Provides strategic planning in setting division objectives.
- Counsels staff regarding clinical decisions or reviews as necessary.
- Performs other duties as assigned to support the TriWest mission.
- Regular and reliable attendance is required.
Competencies
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Independent Thinking / Self-Initiative: Critical thinker with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Technical Skills: Experience managing a significant section of a health care organization; experience with health care services; comprehensive knowledge of clinical quality management; comprehensive knowledge of managed care; knowledge of budgeting processes; business planning experience; experience developing annual budget and staffing projections; proficient with Microsoft Word, Excel, Outlook, PowerPoint and the use of the Internet.
Leadership: Successfully manage diverse workforce; provide clear direction and effective coaching.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail oriented.
Working Conditions
Working Conditions:
- Available to work non-regular hours as required
- Works within a standard office environment, with significant travel
- Extensive computer work, with prolonged sitting
- Security clearance as needed
