Field Medical Director, Interventional Cardiology
Evolent
part-time
Posted on:
Location Type: Remote
Location: Remote • 🌎 Anywhere in the World
Visit company websiteSalary
💰 $120 - $140 per hour
Job Level
Lead
About the role
- Provide expert reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (e.g., cardiac catheterizations, coronary interventions, endovascular procedures, implantable cardiac devices, etc) that do not initially meet medical necessity guidelines or require further evaluation by a subject matter expert.
- Conduct peer-to-peer discussions with treating providers to ensure appropriate, high-value care aligned with clinical guidelines.
- Collaborate with leadership, management, and clinical staff to address complex cases and support decision-making.
- Act as a key resource for Initial Clinical Reviewers, offering guidance and expertise to ensure the application of best practices.
- Provides clinical rationale for standard and expedited appeals.
- Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
- Utilizes 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 Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
- Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
- Participates in on-going training per inter-rater reliability process.
- May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
- On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.
Requirements
- MD/DO/MBBS Degree
- Current, unrestricted clinical license in medicine or required specialty
- Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs
- Active Board Certification in Interventional Cardiology or may be substituted for one of the following: Active Board Certification in Cardiology and proof of prior board certification in Interventional Cardiology
- Active Board Certification in Cardiology and proof of active practice as an Interventional Cardiologist for 5+ years
- Strong clinical, management, communication, and organizational skills
- Energetic and curious with a passion for quality and value in health care
- Computer Proficiency
- Minimum of five (5) years’ experience in the practice of Cardiology is preferred
- 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 Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.
- No history of a major disciplinary or legal action by a state medical board.
Benefits
- A meaningful way to contribute to patient care beyond the clinical setting.
- Opportunities for collaboration with a dynamic team of physicians, leaders, and clinical professionals.
- A role that values innovation, continuous improvement, and clinical excellence.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
cardiac catheterizationscoronary interventionsendovascular proceduresimplantable cardiac devicesclinical review guidelinesutilization managementpeer-to-peer discussionsmedical necessity guidelinesinterventional cardiologycardiology
Soft skills
clinical skillsmanagement skillscommunication skillsorganizational skillsleadershipcollaborationguidancedecision-makingpassion for qualitycuriosity
Certifications
MDDOMBBSactive board certification in interventional cardiologyactive board certification in cardiology