FirstWave Talent Strategies has been retained to identify a Physician for a growth-oriented healthcare organization committed to clinical excellence and long-term value creation. This physician will deliver comprehensive patient care, contribute to quality outcomes, and support the organization’s clinical standards across care delivery environments. The Physician will serve as a trusted medical professional, ensuring evidence-based practice, regulatory adherence, and continuity of care. This role requires sound clinical judgment, professional maturity, and the ability to collaborate effectively within multidisciplinary teams. Responsibilities - Conduct thorough patient assessments through history-taking and physical examinations. - Diagnose medical conditions and develop treatment plans tailored to individual patients. - Prescribe medications and therapies as needed, while educating patients on their health conditions. - Collaborate with healthcare professionals to coordinate comprehensive patient care. - Maintain accurate and detailed medical records in compliance with regulatory standards. - Stay updated on medical advancements and best practices in patient care. - Participate in health promotion and disease prevention initiatives within the community.

• Provide oversight for Berry Street clinical pathway programs requiring medical guidance (including Medicare-regulated programs such as ACCESS and ELEVATE), ensuring patients receive safe, evidence-based care within a dietitian-led model. • Establish and maintain clinical standards, protocols, and escalation pathways to ensure patients receive the right level of care at the right time. • Support regulatory applications and ongoing compliance, including required physician supervision and sign-off. • Order and oversee diagnostic labs (as applicable) to support clinical monitoring and outcomes measurement. • Partner closely with registered dietitians and care operations to ensure coordinated, patient-centered care across nutrition, lifestyle, and medical considerations. • Serve as a senior clinical representative in payer, partner, and pharma conversations, reinforcing Berry Street’s clinical credibility and philosophy. • Contribute clinical input to program design and long-term strategy as Berry Street expands metabolic and nutrition care offerings.

• Responsible for becoming familiar with the standards of practice for assisted living • Achieving a proficient level of competency within all departments of the Community • Assisting in the overall operation of the Community while completing the required training hours for certification or licensure

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description In support of the CMO, the Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health (NH) members. This individual will be chair of at least 3 committees related to quality and accreditation. Location: - Candidates must reside in the state of Wisconsin for consideration. - This position is eligible to work at your home office (reliable internet is required). - Travel is required occasionally for the position. Hours: - 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday. - Weekend coverage required on a rotational basis. Job Responsibilities: - Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers. - Participate in oversight and clinical decision making of the UM program, including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards. - Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. - In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes. - Provide medical consultation as requested for: - Medical/legal issues - Member grievance procedures - Development and implementation of new benefit packages and the interpretation of covered benefits in NHP contracts - Medical issues related to contract negotiations with health care providers - Determining if services to members/enrollees meet medical criteria - Promote positive relationship between NHP and medical community. - Serve as liaison between NHP and providers regarding matters of medical policy and medical administration. - Serve as spokesperson for NHP in the medical community and maintains appropriate contact with professional health care organizations. - Participates in the ongoing recruitment of plan physicians. - Respond to physicians and other provider inquiries and complaints within established guidelines of the Executive Committee and Board of Directors. - Assist in the development of appropriate medical guidelines and parameters for claims review. - Assist in the training of NHP staff on matters relating to medical guidelines. - Oversight responsibility for monitoring and evaluating Medicare Special Needs Plan Model of Care effectiveness. - Perform second level review of provider appeals and disputes. - Serve on committees as coordinated with the CMO. - Assist in strategic planning targeted towards plan growth initiatives. Qualifications - Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction. - Member in good standing of the local medical community. - An active practitioner of medicine in the NHP service areas. - Must possess a thorough knowledge of the health professional and facilities and standards of practice of medicine in NHP’s service area. - Must possess sufficient medical experience and other experience, including knowledge of the Medicare program, to review organization determinations involving medical necessity. - Board certified in an ABMS medical specialty required. Company Description Network Health is an Equal Opportunity Employer.