Medical Director

Medical Director – Surgery, Orthopedics & PM&R

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### Role Summary

Are you an accomplished physician leader seeking a prestigious, high-impact executive position with a strong work-life balance? We are actively recruiting a Medical Director specializing in Surgery, Orthopedics, or Physical Medicine & Rehabilitation (PM&R) to provide strategic clinical leadership for TriWest Healthcare Alliance. This physician executive role focuses completely on utilization management, medical necessity reviews, appeals, and clinical governance supporting military members, veterans, and their families. To ensure our leaders maintain sharp, active clinical judgment, this position features a unique dual-practice model: you will dedicate 75% of your time (3 days per week) to TriWest's remote administrative operations and 25% (1 day per week) to your own private practice or locum tenens work. Step into a highly collaborative, tech-forward infrastructure where your specialized medical insights drive macroscopic healthcare transformation.

### Duties & Responsibilities

#### Clinical Governance & Utilization Review

• Coverage Determinations: Evaluate complex surgical, orthopedic, rehabilitation, and specialty care cases, making accurate coverage and medical necessity determinations based on evidence-based guidelines.
• Appeals & Peer Reviews: Direct robust clinical appeals reviews and conduct collaborative peer-to-peer discussions with network providers.
• Policy Development: Provide expert clinical guidance to support the development, enhancement, and implementation of healthcare policies and quality oversight structures.
• Operational Collaboration: Partner closely with clinical operations, provider relations, quality management, and executive leadership teams to optimize network performance.
• Performance Frameworks: Monitor key performance indicators (KPIs) and