Evolent

Field Medical Director, Oncology

Evolent

part-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $120 - $130 per hour

Job Level

Lead

About the role

  • 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)