Evolent Field Medical Director, Cardiology in Dover, Delaware
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 the 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'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.
What You’ll Be Doing:
* As a Cardiology Field Medical Director, you will be a key member of the utilization management team, providing a meaningful way to make a difference in patients' lives in a non-clinical environment.
Serve as the specialty match reviewer in Cardiology cases that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Provides clinical rationale for standard and expedited appeals.
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
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.
Ensures documentation of all communications with medical office staff and/or MD providers is recorded in a timely and accurate manner.
Participates in ongoing training per inter-rater reliability process.
May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.
Qualifications - Required and Preferred:
* MD/DO/MBBS Degree
* Current, unrestricted clinical license in medicine or required specialty
* Active Board Certification in Cardiology, Vascular Surgery, or Adult Congenital Heart Disease
* Strong clinical, management, communication, and organizational skills
* Minimum of five (5) years’ experience in the practice of Cardiology is preferred
* No history of a major disciplinary or legal action by a state medical board
Technical Requirements:
We require that all employees have the following technical capability at their home: High-speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
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.
The expected base salary/wage range for this position is $120-$135/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees.
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