Field Medical Director, MSK Surgery
Evolent
Field Medical Director, Pain Management
Evolent
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $100 - $110 per hour
Job Level
Lead
About the role
- Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet applicable medical necessity guidelines
- Review imaging requests when providers, clients, or state laws require specialty reviews by the subject matter expert
- Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers within the regulatory timeframe
- Utilize medical/clinical review guidelines and parameters to assure consistency and compliance with SBU policies/procedures, URAC, and NCQA guidelines
- Provide clinical rationale for standard and expedited appeals
- Ensure documentation of all communications with medical office staff and/or MD providers is recorded timely and accurately
- Participate in ongoing training per inter-rater reliability process
- May function as Medical Director for selecting health plans or regions on request, working with the Senior Medical Director
- May assist the Senior Medical Director in research activities/questions
- Routinely interact with leadership and management staff, other Physicians, and staff; aid and act as a resource to Initial Clinical Reviewers
Requirements
- MD/DO/MBBS - Required
- Minimum of five (5) years’ experience in the practice of Pain Medicine, post-residency - Preferred
- Current, unrestricted clinical license in medicine or required specialty - Required
- Obtaining and maintaining medical licenses in the state you reside and any required per business needs - Required
- Active Board Certification in Pain Management OR Active Board Certification in another specialty plus clinical experience in Interventional Pain Management - Required
- 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
- To comply with HIPAA security standards, identity verification may be required as part of the application process
- Technical: High speed internet over 10 Mbps and, for call center employees, ability to plug in directly to home internet router
