Job Summary
Job Description
The Spectrum Healthcare Resources Behavioral Health (BH) Medical Director assists in integrating BH into the TriWest program and their processes; maintaining a BH network that is highly reliable, high quality and educated in the delivery of healthcare services to those who are serving or have served in the military and their dependents. The BH Medical Director functions as a BH subject matter expert to TriWest leadership and medical management staff. They consult directly with TriWest staff on Behavioral Health issues and assist in strategic initiatives to improve the safety and efficiency of the delivery of care through the network primarily via actions in utilization management, case management, quality oversight and other medical management roles. They support TriWest’s mission, values and goals assuring meet or exceed contractual and program standards. Using independent problem-solving skills, they respectfully help resolve concerns throughout the healthcare experience. Reports to the TriWest Behavioral Health Chief Medical Officer (CMO).
Required
Education & Experience
- 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
- Board Eligible or preferably Board Certified in Psychiatry
- 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
- Experience using InterQual and/or similar evidence-based criterial to assess medical interventions, procedures and treatments.
Key Responsibilities
- Makes timely accurate BH coverage determinations in accordance with government contracts using objective evidence and clinical practice guidelines. Responds within contract requirements to reconsideration and appeal requests, including peer to peer discussions where requested.
- Provides subject matter expertise to the clinical staff at all levels of care in the network and in TriWest’s medical management plans. Shares psychiatric expertise regarding transitions of care such as home care, discharge planning, case management, and disease management.
- Advises leadership of Utilization Management (UM), Clinical Quality Management (CQM), Case Management (CM), Disease Management (DM), Population Health (PH) and other TriWest staff on BH best practices for the coordination and advancement of individual and collective beneficiary well-being. Supports medical management staff in conducting clinical case reviews and focused studies to evaluate safety and efficiency in the network. Performs medical necessity review and peer to peer discussions to facilitate timely delivery of
Contact
Joseph Day
Senior Recruiter
Spectrum Healthcare Resources
12647 Olive Blvd | Suite 600 | St. Louis, MO 63141
Toll Free: 1-800-325-3982 ext. 54138
Direct: 314-744-4138
www.spectrumhealth.com
Company Overview
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 860 civilian and military hospitals with a team of 9,800 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
US-OR-Portland
Recruiter : Full Name: First Last
Joseph Day
Direct phone number
3147444138
Recruiter : Email
[email protected]