Field Medical Director, Oncology

Evolent

part-time

Posted on: 8/26/2025

Location: 🇺🇸 United States

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💰 $120 - $130 per hour

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

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)