Evolent

Field Medical Director, MSK Surgery

Evolent

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Job Level

Lead

About the role

  • Key member of the utilization management team providing non-clinical review support
  • Serve as the Physician match reviewer for Hip/Knee/Shoulder Surgery cases and other imaging requests requiring specialty review
  • Discuss determinations (peer-to-peer calls) with requesting physicians/providers within regulatory timeframes and provide clinical rationale for appeals
  • Utilize medical/clinical review guidelines and parameters to ensure consistency and compliance with SBU policies, 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 is timely and accurate
  • May assist the Senior Medical Director in research activities related to Utilization Management, interpretation, guidelines and/or system support
  • Participate in on-going training per inter-rater reliability process
  • Opportunity to make a meaningful difference in patients’ lives in a non-clinical environment

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
  • 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
  • Compliance with HIPAA identity verification may be required as part of application process
  • Home technical requirements: High speed internet over 10 Mbps and ability to plug directly into the home internet router (for call center employees)