Field Medical Director, MSK Surgery

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $140 - $150 / hour

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Evolent

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🏥 Healthcare

☁️ 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

• Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases that do not initially meet applicable medical necessity guidelines • Review other imaging requests when specialty review is required by providers, clients, or state laws • Discuss determinations with requesting physicians or ordering providers through peer-to-peer calls within regulatory timeframes • Provide clinical rationale for standard and expedited appeals • Use medical/clinical review guidelines and parameters to ensure consistency, appropriate utilization, and compliance with SBU policies/procedures, URAC, and NCQA guidelines • Act as a resource to Initial Clinical Reviewers • Document communications with medical office staff and physician providers accurately and promptly • Assist the Senior Medical Director with utilization management research, interpretation, guidelines, and/or system support • Participate in ongoing training through the inter-rater reliability process • Routinely interact with leadership, management staff, physicians, and other 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 highly 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 Orthopedic Surgery • Strong clinical, management, communication, and organizational skills • Computer proficiency • Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid • No history of a major disciplinary or legal action by a state medical board • High-speed internet over 10 Mbps at home • Ability for call center employees to plug directly into the home internet router • Government-issued photo ID submission and identity verification during interviews • Comprehensive background check • In-person I-9 verification • May be subject to drug screening prior to employment

🏖️ Benefits

• Work/life balance • Flexible work arrangements • Autonomy to get things done • Supportive and inclusive work environment • Comprehensive benefits, including health insurance benefits, for qualifying employees