Family Medicine Physician Reviewer – Field Medical Director, Radiology

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🕒 May 22

🇺🇸 United States – Remote

💵 $95 - $96 / hour

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Evolent

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ SaaS

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.

📋 Description

• Currently seeking Family Medicine Physicians to join our Radiology department. • Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. • 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. • Aids and acts as a resource to Initial Clinical Reviewers. • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. • 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 • Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs • 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, 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)