Field Medical Director, MD/DO

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September 26

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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

• Key member of the utilization management team focused on imaging • Serve as the Physician match reviewer in Imaging cases that do not meet medical necessity guidelines • Conduct specialty reviews when providers, clients, or state laws require subject matter expert review • Discuss determinations via peer-to-peer phone calls with requesting physicians within regulatory timeframes and provide clinical rationale for appeals • Utilize medical/clinical review guidelines to ensure consistency, appropriate utilization, and compliance with SBU policies, URAC and NCQA guidelines • Aid and act as a resource to Initial Clinical Reviewers • Ensure documentation of all communications with medical office staff and/or MD provider is recorded timely and accurately • May assist the Senior Medical Director in research activities/questions related to Utilization Management process, interpretation, guidelines and/or system support • Participate in on-going training per inter-rater reliability process • Routinely interact with leadership, other physicians, and staff when physician input is needed

🎯 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 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 • 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) • No history of a major disciplinary or legal action by a state medical board • To comply with HIPAA security standards, identity verification may be required as part of the application process • Technical requirement: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router

🏖️ Benefits

• Comprehensive benefits (including health insurance benefits) to qualifying employees • Eligible for a bonus component that is dependent on pre-defined performance factors • Work at Home / remote work and flexible work arrangements promoting work/life balance • Autonomy and collaborative culture • On-going training and professional development opportunities • Reasonable accommodations available upon request