Field Medical Director, UM Physical Medicine

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of 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 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:

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 physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers. 

What you’ll 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 Evolent's 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.