Field Medical Director, Radiology (Full-Time)

Evolent

5d•Remote

About The Position

Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans. Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

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 home state medicine or required specialty- Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs
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
Employees must have a high-speed broadband internet connection with a minimum speed of 50 Mbps and the ability to set up a wired connection to their home network to ensure effective remote work.

Responsibilities

Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
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, interpretation, guidelines and/or system support.
Participates in on-going training per inter-rater reliability process.