Field Medical Director, UM Physical Medicine

Your Future Evolves Here

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 physicians input is needed or required. As well as aids and acts as a resource to Initial Clinical Reviewers.

What youll be doing:

• 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 Evolents 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 R
• 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 and is not identified as an excluded person by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA) or reprimanded or sanctioned by Medicare.
• No history of a major disciplinary or legal action by a state medical board

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 and specifically for all call center employees the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

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 for further assistance.