Field Medical Director, (Orthopedic Surgery)MSK Surgery

Overview

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of a 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 the autonomy they need to get things done. We believe that people do their best work when they are supported to live their best lives, and when they feel welcome to bring their whole selves to work. Diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What Youll Be Doing

As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We offer a meaningful way to make a difference in patients lives in a non-clinical environment, with better work?life balance and a collaborative, learning-focused culture that aims for better health outcomes.

Collaboration Opportunities

Routinely interacts with leadership and management staff, other physicians, and staff when a physician input is needed or required.

Responsibilities

Serve as the physician match reviewer in Hip/Knee/Shoulder Surgery cases that do not initially meet medical necessity guidelines, as well as other 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, when available, within regulatory timeframes and provide clinical rationale for standard and expedited appeals.

Utilize medical/clinical review guidelines and parameters to ensure consistency in the MD review process, reflecting appropriate utilization and compliance with SBU policies/procedures, URAC and NCQA guidelines.

Aid and act as a resource to Initial Clinical Reviewers.

Ensure documentation of all communications with medical office staff and/or MD providers 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.

Participate in ongoing training per inter-rater reliability process.

Qualifications

MD/DO/MBBS

Minimum of five (5) years of practice experience; active clinical practice within the last 2 years is highly preferred

Current, unrestricted clinical license in medicine or required specialty

Obtaining and maintaining medical licenses in the state of residence, and any license required per business needs

Active Board Certification in Orthopedic Surgery

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; not identified as an excluded person by the Office of Inspector General or GSA; not reprimanded or sanctioned by Medicare

No history of major disciplinary or legal action by a state medical board

HIPAA and security notice: To comply with HIPAA security standards (45 C.F.R. 164.308(a)(3)), identity verification may be required as part of the application process. This information is collected for compliance and security purposes and reviewed only if an applicant advances to the final interview stage. Reasonable accommodations are available upon request.

Technical Requirements

We require that all employees have the following technical capability at home: high-speed internet over 10 Mbps and, specifically for call center employees, the ability to plug in directly to the home internet router. These at-home requirements are subject to change with any scheduled re-opening of our office locations.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need a reasonable accommodation to access the information on this website, please contact for further assistance.

The expected base salary/wage range for this position is $. This position is also eligible for a bonus component based on pre-defined performance factors. As part of our total compensation package, Evolent offers comprehensive benefits (including health insurance) to qualifying employees. Compensation determinations are based on the skills and experience required for the position and may vary above or below the stated amounts.

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