Field Medical Director, Vascular Surgery (Part-time or Full-time)

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done.

Requirements

• Serve as the specialty match reviewer in Vascular cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request
• Provides clinical rationale for standard and expedited appeals
• 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
• 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
• May function as Medical Director for selecting health plans or regions

Benefits

• Comprehensive benefits
• Health insurance benefits