Medical Director

Job Description

Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited medical school.
• Active, unrestricted license to practice medicine in the United States.
• Board certification or board eligibility through a recognized specialty board.
• U.S. Citizenship.
• Favorable background investigation through the Department of Defense (DoD).
• Minimum of 5 years of medical practice experience.
• 3+ years of experience in managed care environments.

Preferred

• Experience working with TRICARE, Veterans Affairs, or other federal health plans.
• Advanced degree in management (MPA, MBA, MHA, MPH).
• Corporate-level leadership experience.
• Experience using InterQual and/or similar evidence-based criterial to assess medical interventions, procedures and treatments.

Job Responsibilities

• Provide program-wide clinical guidance across multiple medical management domains including Utilization Management, Case Management, Quality, and Public Health.
• Lead and participate in quality committees and collaborative safety initiatives.
• Review member cases for appropriateness and quality of care; document findings in CareRadius and other health systems.
• Conduct peer-to-peer discussions with network providers and internal stakeholders.
• Develop and implement corrective action plans related to clinical quality or provider performance.
• Collaborate closely with TriWest teams such as Clinical Operations, Data Analytics, and General Counsel.
• Provide clinical expertise on new technologies, treatment protocols, and population health initiatives.
• Interact with veterans and beneficiaries to support satisfaction and outcomes.
• Stay current with required licensure, board certification, and federal medical standards.

Working Conditions

• Remote position with standard weekday hours and occasional after-hours availability.
• Extensive computer-based work; prolonged periods of sitting may be necessary.

Company Overview