Profile
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!
We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)
Job Summary
Oversees and participates in clinical quality reviews, peer review, and provider interactions. 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. Chairs and coordinates quality and other committee meetings as assigned. Documents reviews of clinical quality and appropriateness of care in the medical management system. 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. Interacts directly with beneficiaries, as indicated, to assure a high level of satisfaction.
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 or proven training to meet board eligibility requirements
- Current unrestricted license to practice medicine in a state or territory of the United States
- 5+ years' medical practice experience
Preferred
- TRICARE, Veterans Affairs, or other government health plan experience
- Advanced management degree (MPA, MBA, MHA, MPH)
- 2+ years' Managed Care experience
Key Responsibilities
- Provides program guidance and clinical oversight for Medical Management programs.
- Engages in peer to peer discussions with network providers and others.
- 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 consultation to staff, as needed, especially RN and other nursing staff.
- Provides oversight for clinical decisions impacting beneficiaries.
- Possesses knowledge of medical practice standards and conducts research, as needed, on new technologies and treatments.
Competencies
Coaching / Training / Mentoring: Actively fosters desired business outcomes through ongoing constructive feedback to others.
Communication / People Skills: Collaborates with and Influences others in both positive and negative circumstances. Adapt to different personalities and behavioral styles. Listens critically.
Computer Literacy: Uses computer hardware and software to effectively research, analyze, and document critical functions.
Coping / Flexibility: Understands and commits to goals and embraces the ideas of others to achieve success.
Independent Thinking / Self-Initiative: Thinks critically with ability to focus on things which matter most to achieving outcomes. Exhibits commitment to tasks to achieve key outcomes without direction. Creatively finds solutions to problems and obtains necessary resources to solve them.
Team-Building / Team Player: Influences the actions and opinions of others in a positive manner. Accepts feedback and incorporates it into actions. Builds group commitment.
Technical Skills: Ability to work in a matrix environment. Proficiency in Microsoft Office applications. Comprehensive knowledge of and ability to participate in and oversee:
- Case Management and Disease Management
- Clinical Quality and Continuous Quality Improvement
- Utilization Management, health care cost containment, and Managed Care practices
- URAC Standards and process and other accreditation standards as needed
- HIPAA regulations and requirements
Working Conditions
Working Conditions
- Regular daytime hours with availability to work additional non-regular hours as needed
- Standard office environment, with limited to moderate travel
- Extensive computer work with prolonged sitting
- Security clearance may be required
Company Overview
Taking Care of Our Nation’s Heroes.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
*Annual base salary for Colorado, Hawaii and Washington State residents: $257,632.00-$286,258 depending on experience*
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
