Field Medical Director - Vascular Surgery

Evolent

93d

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 - Required
• Minimum of five (5) years’ experience in the practice of Vascular Surgery - Preferred
• Current, unrestricted clinical license in medicine or required specialty - Required
• Obtaining and maintaining medical licenses in the state you reside - Required
• Active Board Certification in Vascular Surgery or Active Board Certification in General Surgery with extensive experience in Vascular Surgery - Required
• Strong clinical, management, communication, and organizational skills - Required
• Energetic and curious with a passion for quality and value in health care - Required
• Computer Proficiency - Required

Responsibilities

• Serve as the specialty match reviewer in Vascular cases that do not initially meet the applicable medical necessity guidelines.
• Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers 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.
• 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.
• Participate in on-going training per inter-rater reliability process.
• Assist the Senior Medical Director in research activities/questions related to the Utilization Management process.
• Function as Medical Director for selecting health plans or regions on a requested basis.

Benefits

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

What This Job Offers

• Number of Employees: 1,001-5,000 employees