Field Medical Director, Pain Management

Job not on LinkedIn

September 25

Apply Now

Receive Emails with Similar Jobs

Evolent

WebsiteLinkedInAll Job Openings

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 Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet applicable medical necessity guidelines • Review imaging requests when providers, clients, or state laws require specialty reviews by the subject matter expert • Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers within the regulatory timeframe • Utilize medical/clinical review guidelines and parameters to assure consistency and compliance with SBU policies/procedures, URAC, and NCQA guidelines • Provide clinical rationale for standard and expedited appeals • Ensure documentation of all communications with medical office staff and/or MD providers is recorded timely and accurately • Participate in ongoing training per inter-rater reliability process • May function as Medical Director for selecting health plans or regions on request, working with the Senior Medical Director • May assist the Senior Medical Director in research activities/questions • Routinely interact with leadership and management staff, other Physicians, and staff; aid and act as a resource to Initial Clinical Reviewers

🎯 Requirements

• MD/DO/MBBS - Required • Minimum of five (5) years’ experience in the practice of Pain Medicine, post-residency - Preferred • Current, unrestricted clinical license in medicine or required specialty - Required • Obtaining and maintaining medical licenses in the state you reside and any required per business needs - Required • Active Board Certification in Pain Management OR Active Board Certification in another specialty plus clinical experience in Interventional Pain Management - Required • Strong clinical, management, communication, and organizational skills - Required • Energetic and curious with a passion for quality and value in health care - Required • Computer Proficiency - Required • To comply with HIPAA security standards, identity verification may be required as part of the application process • Technical: High speed internet over 10 Mbps and, for call center employees, ability to plug in directly to home internet router

🏖️ Benefits

• Comprehensive benefits (including health insurance benefits) to qualifying employees • Position eligible for a bonus component dependent on pre-defined performance factors • Work/life balance and flexibility to suit their work to their lives • Autonomy to complete work • Diversity and inclusion-focused culture • Reasonable accommodations available upon request