Field Medical Director, Cardiology

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April 29

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Evolent

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Healthcare Insurance • Healthcare • SaaS

Evolent is a healthcare company focused on improving care outcomes through its comprehensive management solutions across multiple medical specialties. They aim to enhance the patient care journey by offering coordinated services in areas like oncology, cardiology, musculoskeletal disorders, and primary care, while ensuring high-quality treatment pathways and cost management. Evolent believes every person deserves quality care, striving to align treatment guidelines and innovative approaches to meet patient needs effectively.

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ SaaS

📋 Description

• Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. • Provides clinical rationale for standard and expedited appeals. • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. • Participates in on-going training per inter-rater reliability process. • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. • On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.

🎯 Requirements

• MD/DO/MBBS Degree • Current, unrestricted clinical license in medicine or required specialty • Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs • Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease • Strong clinical, management, communication, and organizational skills • Energetic and curious with a passion for quality and value in health care • Computer Proficiency • Minimum of five (5) years’ experience in the practice of Cardiology is preferred • Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. • No history of a major disciplinary or legal action by a state medical board

🏖️ Benefits

• comprehensive benefits (including health insurance benefits) to qualifying employees