Medical Director - REMOTE

TRIWEST HEALTHCARE ALLIANCE

MEDICAL DIRECTOR – UTILIZATION MANAGEMENT / MEDICAL NECESSITY REVIEW

JOB ORDER NOTES / RECRUITER HANDOFF

CLIENT:
TriWest Healthcare Alliance

POSITION:
Medical Director

EMPLOYMENT TYPE:
Contract

WORK ARRANGEMENT:
100% Remote

APPROVED WORK STATES:
AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY

COMPENSATION:
Targeting $140 - $145/hr
Pre-negotiate all candidates whenever possible.

IMPORTANT CLIENT UPDATE

The client has requested that sourcing efforts move away from Pediatrics.

Preferred specialties are:

• Orthopedic Surgery
• General Surgery
• OB/GYN
• Physical Medicine & Rehabilitation (PM&R)

Secondary consideration:

• Family Medicine
• Internal Medicine
• Other physician specialties with strong utilization management and medical necessity review experience

OVERVIEW

TriWest is seeking a Medical Director to provide utilization management, medical necessity review, appeals review, and physician leadership support. Candidates should possess strong managed care, health plan, utilization review, peer-to-peer, and clinical decision-making experience.

The ideal candidate will have experience reviewing surgical, orthopedic, rehabilitation, women's health, and specialty care services while collaborating with interdisciplinary teams and operational leadership.

MUST HAVE REQUIREMENTS

• MD or DO
• Active unrestricted medical license
• Board Certified
• Medical Director, Associate Medical Director, Physician Advisor, or Physician Reviewer experience preferred
• Managed Care, Health Plan, Medicare Advantage, Medicaid, Commercial Insurance, VA, DoD, TRICARE, or Utilization Management experience
• Medical Necessity Review experience
• Appeals Review experience
• Peer-to-Peer Review experience
• Strong clinical documentation review experience
• Experience making coverage determinations based upon evidence-based guidelines
• Strong communication and physician leadership skills

HIGHLY PREFERRED

• Orthopedic Surgery
• General Surgery
• OB/GYN
• PM&R

PREFERRED INDUSTRY BACKGROUNDS

• Health Plans
• Medicare Advantage
• Medicaid
• Managed Care Organizations
• Independent Review Organizations
• Government Healthcare Programs
• Military Healthcare Programs
• TRICARE
• Veterans Affairs
• Commercial Insurance Carriers

TARGET COMPANIES

• UnitedHealthcare / Optum
• Humana
• Aetna
• Cigna
• Elevance
• Blue Cross Blue Shield Plans
• Centene
• Molina
• Kaiser Permanente
• Evolent
• Maximus
• Telligen
• Kepro / Acentra
• TriWest
• Veterans Affairs

TARGET TITLES

• Medical Director
• Associate Medical Director
• Physician Reviewer
• Physician Advisor
• Utilization Management Medical Director
• Medical Management Medical Director
• Appeals Medical Director
• Clinical Review Medical Director

INTERVIEW PROCESS

1. Recruiter Screen
2. TEEMA Submission
3. Client Review
4. Interview(s)
5. Offer

Candidate Name:

Current Location:

Phone:

Email:

Specialty:

Board Certification(s):

Active License State(s):

Current Employer:

Current Title:

Compensation Requirement:

Interview Availability:

Time Off Requested Next 90 Days:

Current or Past Family Members at TriWest?
If yes, list name(s), relationship(s), and role(s):

Available to Start:

SUMMARY OF QUALIFICATIONS

• Specialty:
• Board Certified:
• Years as Physician:
• Years in Medical Director Role:
• Managed Care Experience:
• Medicare Advantage Experience:
• Medicaid Experience:
• Commercial Health Plan Experience:
• Utilization Management Experience:
• Medical Necessity Review Experience:
• Appeals Review Experience:
• Peer-to-Peer Experience:
• Physician Advisor Experience:
• Leadership Experience:
• Additional Highlights:

CLINICAL SPECIALTY EXPERIENCE

• Orthopedic Surgery:
• General Surgery:
• OB/GYN:
• PM&R:
• Family Medicine:
• Internal Medicine:
• Other Specialty:

REASON FOR LEAVING

Current Employer:

Previous Employer:

WORK ELIGIBILITY

Authorized to work in U.S.:
Yes / No

Requires Sponsorship:
Yes / No

ADDITIONAL NOTES

• Candidate understands contract structure.
• Candidate understands compensation range discussed.
• Candidate available to start on: __________.
• Candidate interested in long-term opportunity: Yes / No.

RECRUITER NOTES

DO NOT PRIORITIZE PEDIATRICIANS.

FOCUS SOURCING ON:

1. Orthopedic Surgery
2. General Surgery
3. OB/GYN
4. PM&R

Look for physicians with significant utilization management, medical necessity review, appeals, and peer-to-peer review experience over purely clinical backgrounds.