Otolaryngologist, Physician Reviewer – Field Medical Director, Radiology

Evolent

Otolaryngologist-Physician Reviewer serving as a match reviewer in non-clinical setting. Collaborating with imaging cases and providing clinical rationale for determinations.

Posted 5/28/2026full-timeRemote • 🇺🇸 United StatesLead💰 $95 - $109 per hourWebsite

About the role

Key responsibilities & impact

Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process
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

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
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

medical necessity guidelinesclinical review guidelinespeer to peer discussionsdocumentationUtilization Management processclinical practicemedical review process

Soft Skills

communication skillsorganizational skillsmanagement skillsenergeticcuriouspassion for qualitypassion for value in health care

Certifications

MDDOMBBSactive clinical licenseactive board certification