Field Medical Director Internal Medicine/ Emergency Medicine (Cardiology)

Evolent

2d•$96 - $100

About The Position

As a IM-EM/Cardiology, Field Medical Director, you will serve as a key member of the Utilization Management team, providing timely, clinically sound medical reviews for cardiology-related service requests that do not initially meet applicable medical necessity guidelines. This role offers a meaningful opportunity to make a measurable difference in patients’ lives within a non-clinical environment, while supporting better health outcomes across member populations. This position promotes improved work–life balance and provides the opportunity to work on a collaborative team that values continuous learning, consistency in clinical decision-making, and professional engagement. The Field Medical Director routinely collaborates with physicians, clinical leadership, management staff, and other Field Medical Directors whenever specialty physician input is needed or required.

Requirements

DO, MD, or MBBS degree from an accredited institution
Current Board Certification in Emergency Medicine or Internal Medicine by an American Certifying Board
Current, unrestricted medical license in one or more U.S. states
Current Unrestricted Medical License in Home State
Demonstrated strong knowledge of diagnostic cardiology, including evaluation and management of cardiovascular conditions, and the appropriate use of cardiac imaging modalities such as echocardiography, nuclear cardiology, cardiac CT, and cardiac MRI to support evidence-based medical necessity determinations
High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Nice To Haves

Five (5) years of post-residency clinical experience
Strong verbal and written communication skills, including the ability to effectively engage in peer-to-peer discussions with treating providers
Proficient computer skills and experience working with clinical review and documentation systems
Active clinical practice experience within the past 18 months
Familiarity with utilization management principles and procedures within managed care organizations, including experience with cost-benefit analysis, quality assurance, and continuous quality improvement processes

Responsibilities

Serve as the specialty-match reviewer for diagnostic cardiology cases that do not initially meet applicable medical necessity guidelines, as well as other requests when providers, clients, or state regulations require specialty reviews to be completed by a cardiology subject matter expert.
Review all cases in which clinical determinations cannot be made by Initial Clinical Reviewers, ensuring appropriate use of evidence-based cardiology guidelines and regulatory standards.
Provide clear, evidence-based clinical rationale for standard and expedited appeals.
Conduct peer-to-peer discussions with requesting physicians or ordering providers, when available, within regulatory timeframes via phone.
Utilize medical and clinical review guidelines and parameters to ensure consistency in physician review processes and appropriate utilization, in alignment with SBU policies and procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) standards.
Assist and act as a clinical resource to Field Medical Directors and Initial Clinical Reviewers to discuss cases, address complex review scenarios, and support problem resolution.
Ensure all communications with medical office staff and/or physician providers are documented accurately and in a timely manner.
Participate in ongoing training initiatives, including inter-rater reliability programs, to promote quality, consistency, and compliance.
Assist the Senior Medical Director, as requested, with research activities and questions related to utilization management processes, guideline interpretation, and system or operational support.
On a requested basis, review appeal cases and/or attend hearings to support utilization management determinations.
On a requested basis, function as Medical Director for select health plans or regions, assuming overall accountability for utilization management activities in collaboration with the Senior Medical Director.