Evolent
1001 - 5000 employees
Evolent partners with health plans and providers to achieve better outcomes for people with complex health conditions. Working across multiple medical specialties and primary care, we seek to ensure that care plans align with clinical evidence, respect members’ goals and preferences, and connect seamlessly across providers and settings. We believe that every person deserves the same level of care and compassion we would want for our loved ones.
Rheumatologist – Physician Reviewer – Radiology
🕒 June 17
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Evolent
1001 - 5000 employees
Evolent partners with health plans and providers to achieve better outcomes for people with complex health conditions. Working across multiple medical specialties and primary care, we seek to ensure that care plans align with clinical evidence, respect members’ goals and preferences, and connect seamlessly across providers and settings. We believe that every person deserves the same level of care and compassion we would want for our loved ones.
📋 Description
• Serve as the Physician match reviewer in Imaging cases that do not initially meet the applicable medical necessity guidelines • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process • 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.
🎯 Requirements
• MD/DO/MBBS • Minimum of five (5) years’ experience in the practice of Medicine, post residency • Active Clinical practice within the last 2 years is preferred • Current, unrestricted clinical license in home state medicine or required specialty • Active Board Certification by an accredited organization • Strong clinical, management, communication, and organizational skills • Energetic and curious with a passion for quality and value in health care • Computer Proficiency • Not under current exclusion or sanction by any state or federal health care program • No history of a major disciplinary or legal action by a state medical board.
🏖️ Benefits
• health insurance benefits
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