Field Medical Director – Internal Medicine, Emergency Medicine, Cardiology
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Job Description
Field Medical Director in cardialogy at Evolent, providing clinical reviews for utilization management. Collaborating with physicians to ensure appropriate care decisions in a non-clinical environment.
Responsibilities:
- Serve as the specialty-match reviewer for diagnostic cardiology cases
- 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
- 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
- Participate in ongoing training initiatives
- Assist the Senior Medical Director with research activities and questions
- Review appeal cases and/or attend hearings to support utilization management determinations
- Function as Medical Director for select health plans or regions as requested
Requirements:
- 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
- Five (5) years of post-residency clinical experience
- Strong verbal and written communication skills, including the ability to effectively engage in peer-to-peer discussions with treating providers
- 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
Benefits:
- Health insurance benefits
- Comprehensive benefits to qualifying employees
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