Details Client NameSpectrum Healthcare Resources Job TypePermanent OfferingPhysician ProfessionPediatrics SpecialtyGeneral Job ID15450942 Job TitleMedical Director Shift Details ShiftFull Time Days Scheduled Hours40 Job Order Details Start Date08/15/2025 Duration0 Job DescriptionPermanent Pediatrics - General - Saint Louis, MO - Full Time Days - Pay Negotiable - Saint Louis, MOEmployer: Spectrum Healthcare ResourcesLocation: Saint Louis, MOJob Type: PermanentShift: Full Time DaysStart Date: September 22, 2025Job Overview•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 - California and Washington prefered - must be open to potentially obtaining more licenses as needed •3+ years medical management experience in a Managed Care environment •Experience with utilization Management, Quality Management, Case Management, and/or Disease Management •Government Healthcare experience (e.g. Tricare, Veterans Affairs) •Collaborates with TriWest staff on issues and programs, including General Counsel, Data Analytics, Communications, Executive Leadership Team, and others, as neededPosition HighlightsEducation & ExperienceRequiredMedical Doctor Degree5+ years clinical practice experiencePreferredAdvanced degree in public health or business2+ years managed care experienceKey ResponsibilitiesProvides program guidance and clinical expertise for Medical Management programsEngages in peer-to-peer discussions with network providers and others, as neededReviews potential quality issues for corrective actionReviews member cases for appropriateness of careParticipates in internal, external, and joint quality and safety meetingProvides clinical expertise to staff, as neededPossesses knowledge of medical practice standards and conducts research, as needed, on new technologies and treatmentsQualificationsThe Spectrum Healthcare ResourcesMedical Director oversees and chairs/participates in committees (e.g. quality management/improvement), as assigned, for T-5/DoD and CCN/VA. Works closely with medical management staff (Clinical Quality Management, Utilization Management, Case Management, Referral Management, Disease Management, Public Health, Clinical Operations, and Clinical Systems) to accomplish Medical Management tasks including clinical quality reviews, peer review, and provider interactions (peer to peer.) 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. Documents reviews of clinical quality and appropriateness of care in CareRadius and other IT systems. 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, in collaboration with Data Analytics and other TriWest staff. Interacts directly with beneficiaries, as indicated, to assure a high level of satisfaction. Obtains and maintains board certification and state licensure in the required states. Occasionally travels and attends meetings, as required. Position is primarily remote work.Board Eligible or preferably Board Certified in PediatricsUpon applying, StaffDNA will connect you directly with the hiring decision-maker-whether that's the facility manager or their dedicated recruiter-to discuss this opportunity in detail and outline your next steps.Client Details Address12647 Olive Blvd CitySaint Louis StateMO Zip Code63141