What are the responsibilities and job description for the Field Medical Director-Pulmonology position at Evolent?
Evolent Field Medical Director-Pulmonology Annapolis, Maryland Apply Now
Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of a 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 the 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.
Join Evolent for the mission. Stay for the culture.
What You’ll Be Doing :
- Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician's input is needed or required.
- Serve as the Physician match reviewer in 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.
- Utilize 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.
- Aid and act as a resource to Initial Clinical Reviewers.
- Ensure documentation of all communications with medical office staff and / or MD providers 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.
- Participate in ongoing training per inter-rater reliability process.
Qualifications :
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.
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