Field Medical Director , Radiology; Urology

Overview

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of a fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they are supported to live their best lives, and when they feel welcome to bring their whole selves to work. That is one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

Job Description

As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work-life balance on a team that values collaboration and continuous learning while providing better health outcomes.

• Routinely interacts with leadership and management staff, other physicians, and staff whenever a physician input is needed or required.

• 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.
• Discuss determinations (peer-to-peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provide clinical rationale for standard and expedited appeals.
• Utilize 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 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 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.
• Participate in ongoing training per inter-rater reliability process.

• MD/DO/MBBS
• Minimum of five (5) years’ experience in the practice of Medicine, post residency and 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, and is not identified as an “excluded person” by the Office of Inspector General of the DHHS or GSA, or reprimanded or sanctioned by Medicare
• No history of a major disciplinary or legal action by a state medical board

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo  conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored.

Misrepresentation will result in immediate disqualification from consideration.

We require that all employees have the following technical capability at their home:
High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in…