Field Medical Director, Oncology

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August 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

• Serve as the Physician match reviewer in Medical Oncology and imaging cases that do not initially meet applicable medical necessity guidelines • Discuss determinations (peer-to-peer calls) with requesting physicians or ordering providers within regulatory timeframes and provide clinical rationale for appeals • Utilize medical/clinical review guidelines to assure consistency with SBU policies/procedures, 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 providers in a timely and accurate manner • May assist the Senior Medical Director in research related to Utilization Management processes, interpretation, guidelines, and system support • Participate in ongoing 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 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 in Medical Oncology • 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 not identified as an “excluded person” by OIG or GSA • No history of a major disciplinary or legal action by a state medical board • To comply with HIPAA identity verification may be required as part of the application process • Technical requirement: high speed internet over 10 Mbps and ability to plug directly into home internet router (for call center roles)

🏖️ Benefits

• Comprehensive benefits (including health insurance benefits) to qualifying employees. • Position is eligible for a bonus component dependent on pre-defined performance factors. • Work/life balance, flexibility to suit employees' lives, and autonomy. • Reasonable accommodations available upon request.