Evolent

Field Medical Director – Vascular Surgery

Evolent

full-time

Posted on:

Origin:  • 🇺🇸 United States

Visit company website
✨ AI Apply
Manual Apply

Job Level

Lead

About the role

  • Key member of the utilization management team handling vascular surgery cases
  • Serve as the specialty match reviewer for vascular cases and other imaging requests when specialty review is required
  • Discuss determinations (peer-to-peer calls) with requesting physicians within regulatory timeframes
  • Provide clinical rationale for standard and expedited appeals
  • Utilize medical/clinical review guidelines and parameters to ensure appropriate utilization and compliance with SBU policies, URAC, and NCQA
  • Act as a resource to Initial Clinical Reviewers and participate in inter-rater reliability training
  • Ensure documentation of all communications with medical office staff and/or MD providers in a timely and accurate manner
  • Assist Senior Medical Director with research related to Utilization Management and may function as Medical Director for selected plans/regions on request
  • Non-clinical role offering improved work-life balance and remote work from home

Requirements

  • MD/DO/MBBS - Required
  • Current, unrestricted clinical license in medicine or required specialty - Required
  • Obtain and maintain medical licenses in the state you reside - Required
  • Active Board Certification in Vascular Surgery or Active Board Certification in General Surgery with extensive experience in Vascular Surgery - Required
  • Minimum of five (5) years’ experience in the practice of Vascular Surgery - Preferred
  • 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
  • Ability to perform peer-to-peer discussions and provide clinical rationale for appeals
  • Familiarity with Utilization Review Accreditation Commission (URAC) and NCQA guidelines
  • High-speed internet over 10 Mbps and ability to plug directly into home internet router (technical requirement)
  • May require identity verification for HIPAA compliance (identity verification collected for applicants advancing to final interview)