[Hiring] Field Medical Director Internal Medicine/ Emergency Medicine (Cardiology) @Evolent

Role Description

As a IM-EM/Cardiology, Field Medical Director, you will serve as a key member of the Utilization Management team, providing timely, clinically sound medical reviews for cardiology-related service requests that do not initially meet applicable medical necessity guidelines. This role offers a meaningful opportunity to make a measurable difference in patients’ lives within a non-clinical environment, while supporting better health outcomes across member populations.

This position promotes improved work–life balance and provides the opportunity to work on a collaborative team that values continuous learning, consistency in clinical decision-making, and professional engagement.

The Field Medical Director routinely collaborates with physicians, clinical leadership, management staff, and other Field Medical Directors whenever specialty physician input is needed or required.

Primary Responsibilities

• Serve as the specialty-match reviewer for diagnostic cardiology cases that do not initially meet applicable medical necessity guidelines.
• Review all cases in which clinical determinations cannot be made by Initial Clinical Reviewers.
• Provide clear, evidence-based clinical rationale for standard and expedited appeals.
• Conduct peer-to-peer discussions with requesting physicians or ordering providers, when available.
• Utilize medical and clinical review guidelines and parameters to ensure consistency in physician review processes.
• Assist and act as a clinical resource to Field Medical Directors and Initial Clinical Reviewers.
• Ensure all communications with medical office staff and/or physician providers are documented accurately and in a timely manner.
• Participate in ongoing training initiatives, including inter-rater reliability programs.
• Assist the Senior Medical Director with research activities and questions related to utilization management processes.
• On a requested basis, review appeal cases and/or attend hearings to support utilization management determinations.
• On a requested basis, function as Medical Director for select health plans or regions.

Qualifications

• DO, MD, or MBBS degree from an accredited institution.
• Current Board Certification in Emergency Medicine or Internal Medicine by an American Certifying Board.
• Current, unrestricted medical license in one or more U.S. states.
• Current Unrestricted Medical License in Home State.
• Demonstrated strong knowledge of diagnostic cardiology, including evaluation and management of cardiovascular conditions.

Preferred Qualifications

• Five (5) years of post-residency clinical experience.
• Strong verbal and written communication skills.
• Proficient computer skills and experience working with clinical review and documentation systems.
• Active clinical practice experience within the past 18 months.
• Familiarity with utilization management principles and procedures within managed care organizations.

Technical Requirements

• High speed internet over 10 Mbps.
• Ability to plug in directly to the home internet router for call center employees.

Benefits

• The expected base salary/wage range for this position is $96-$100/hr.
• This position is also eligible for a bonus component based on pre-defined performance factors.
• Evolent offers comprehensive benefits, including health insurance benefits, to qualifying employees.

Company Description

Evolent partners with health plans and providers to achieve better outcomes for people with complex and costly health conditions. 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.