[Hiring] Field Medical Director @Evolent

Role Description

Evolent is looking for a Field Medical Director to be a member of the Evolent clinical team. As a collaborative member of a team of clinicians, physicians, pharmacists, health economists, and program coordinators, you will have the opportunity to make a profound impact on the lives of our members. Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician's input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers.

• Supports pre-admission review, utilization management, and concurrent and retrospective review process.
• Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs.
• Assists with execution of Evolent's benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs.
• Participate in the Appeals and Grievance process, as necessary, to assure timely and accurate responses to members.
• Supports design and implementation of health plan medical policies, and appropriate Care Management and UM goals and objectives.
• Population health – collaborative care management leadership.
• Provides clinical leadership and development for population health programs or functional areas within Medical Management.
• Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
• Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers.
• Participate in committees as assigned.
• Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.
• Evaluates and ensures systems and processes to assist providers with adherence to evidence-based protocols.
• Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.

Qualifications

• Active Board Certification by an American Certifying Board (If a specialty or subspecialty, must have that BC).
• 1+ years of Utilization Review Experience.
• Graduate of an accredited medical school. Either MD or DO degree is required.
• Active physician license without any restrictions.
• 3-5 years of clinical practice in a primary care setting and progressively responsible medical administrative experience preferred.
• Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder.
• A thorough understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient-centered medical home concepts.
• Excellent interpersonal, verbal, and written communication skills.
• Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.
• Ability to navigate in a corporate matrix environment is preferred.
• Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid.
• No history of a major disciplinary or legal action by a state medical board.

Requirements

• To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID.
• We conduct identity verification during interviews, and final interviews may require onsite attendance.
• All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment.
• The use of artificial intelligence tools during interviews is prohibited and monitored.
• Misrepresentation will result in immediate disqualification from consideration.

Technical Requirements

• We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps.
• Specifically for all call center employees, the ability to plug in directly to the home internet router.

Benefits

• The expected base salary/wage range for this position is $120-130.
• 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.