Family Medicine Physician Reviewer – Field Medical Director, Radiology

Evolent

Family Medicine Physician joining Radiology department for utilization management and imaging case reviews. Engaging in clinical discussions and ensuring compliance with medical necessity guidelines.

Posted 5/22/2026full-timeRemote • 🇺🇸 United StatesLead💰 $95 - $96 per hourWebsite

About the role

Key responsibilities & impact

Currently seeking Family Medicine Physicians to join our Radiology department.
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
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.
Aids and acts as a resource to Initial Clinical Reviewers.
Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
Participates in on-going training per inter-rater reliability process.

Requirements

What you’ll need

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 preferred
Current, unrestricted clinical license in home state 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 by an accredited organization
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 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

Comp & perks

comprehensive benefits (including health insurance benefits)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical reviewmedical necessity guidelinesutilization managementpeer to peer discussionsdocumentationresearch activitiesinter-rater reliability

Soft Skills

communicationorganizationalmanagementenergeticcuriouspassion for quality and value

Certifications

MDDOMBBSactive board certificationclinical license