Transform Healthcare Outcomes with Us

">

Evolent collaborates with healthcare providers and plans to deliver better results for individuals struggling with complex health issues. By combining specialties and primary care, we strive to bridge the gaps in the fragmented healthcare system and ensure people receive the same level of care and compassion they would want for their loved ones.

">

Our team members enjoy a great work-life balance, flexibility to align their work with their life, and the autonomy they need to achieve their goals. We believe that people perform best when they are supported to live their best lives and feel welcome to bring their whole selves to work. That's why diversity and inclusion are fundamental to our business.

">

Join us on this mission. Stay for the culture.

">

What You'll Be Doing

">

As a Vascular Surgery Field Medical Director, you will be an integral part of our utilization management team. This role offers a meaningful opportunity to make a difference in patients' lives in a non-clinical environment. You can enjoy a better work-life balance while working collaboratively and continuously learning, providing better health outcomes.

">

Collaboration Opportunities

">

You will regularly interact with leadership and management staff, physicians, and other staff when a physician's input is required or needed.">

">

Key Responsibilities

">

Act as the specialty match reviewer in Vascular cases that do not initially meet applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by subject matter experts.">
Discuss determinations (peer-to-peer phone calls) with requesting physicians or ordering providers when available, within the regulatory timeframe of the request.">
Provide clinical rationale for standard and expedited appeals.">
Utilize medical/clinical review guidelines and parameters to ensure consistency in the MD review process, reflecting appropriate utilization and compliance with policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.">
Support Initial Clinical Reviewers and act as a resource for them.">
Ensure accurate and timely documentation of all communications with medical office staff and/or MD providers.">
Participate 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 – Required">
Minimum of five (5) years' experience in the practice of Vascular Surgeon – Preferred">
Current, unrestricted clinical license in medicine or required specialty – Required">
Obtaining and maintaining medical licenses in the state you reside – Required">
Active Board Certification in Vascular Surgery or Active Board Certification in General Surgery with extensive experience in Vascular Surgery – Required">
Strong clinical, management, communication, and organizational skills – Required">
Energetic and curious with a passion for quality and value in healthcare – Required">
Computer Proficiency – Required">

">

Technical Requirements

">

We require all employees to 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.

">

Benefits

">

Comprehensive benefits package to qualifying employees, including health insurance benefits.

">

Equal Opportunity Employer

">

Considered all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Qualifications

Benefits

You can enjoy a better work-life balance while working collaboratively and continuously learning, providing better health outcomes
Comprehensive benefits package to qualifying employees, including health insurance benefits

Responsibilities

As a Vascular Surgery Field Medical Director, you will be an integral part of our utilization management team
This role offers a meaningful opportunity to make a difference in patients' lives in a non-clinical environment
You will regularly interact with leadership and management staff, physicians, and other staff when a physician's input is required or needed.">
Act as the specialty match reviewer in Vascular cases that do not initially meet applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by subject matter experts.">
Discuss determinations (peer-to-peer phone calls) with requesting physicians or ordering providers when available, within the regulatory timeframe of the request.">
Provide clinical rationale for standard and expedited appeals.">
Utilize medical/clinical review guidelines and parameters to ensure consistency in the MD review process, reflecting appropriate utilization and compliance with policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.">
Support Initial Clinical Reviewers and act as a resource for them.">
Ensure accurate and timely documentation of all communications with medical office staff and/or MD providers.">
Participate 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.">

Medical Director of Vascular Surgery Transformation

Job Type