Field Medical Director, Oncology (Charleston)

Join Evolent

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.

What You'll Be Doing :

• Serve as the physician match reviewer in medical oncology and 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.
• Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provide 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 ongoing training per inter-rater reliability process.

Qualifications :

To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.

Technical requirements :

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.

If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary / wage range for this position is $120-130 / 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. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.