Field Medical Director, (Medical Oncology)

Evolent

136d • $120 - $130

About The Position

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. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

Requirements

• 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 medicine or required specialty.
• Active Board Certification in Medical Oncology.
• 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.
• No history of a major disciplinary or legal action by a state medical board.

Responsibilities

• Serve as the Physician match reviewer in Medical Oncology and imaging cases that do not initially meet the applicable medical necessity guidelines.
• Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
• Provide clinical rationale for standard and expedited appeals.
• Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process.
• Reflect appropriate utilization and compliance with SBU's policies/procedures, as well as 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 provider is recorded in a timely and accurate manner.
• Assist the Senior Medical Director in research activities/questions related to the Utilization Management process.
• Participate in ongoing training per inter-rater reliability process.

Benefits

• Comprehensive health insurance benefits.
• Bonus component dependent on pre-defined performance factors.

What This Job Offers

• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees