healthcare
Posted May 29Field Medical Director Internal Medicine/ Emergency Medicine (Cardiology)
at Evolent
GlobalRemote
Responsibilities
- Review all cases in which clinical determinations cannot be made by Initial Clinical Reviewers, ensuring appropriate use of evidence-based cardiology guidelines and regulatory standards.
- Conduct peer-to-peer discussions with requesting physicians or ordering providers, when available, within regulatory timeframes via phone.
- Utilize medical and clinical review guidelines and parameters to ensure consistency in physician review processes and appropriate utilization, in alignment with SBU policies and procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) standards.
- Ensure all communications with medical office staff and/or physician providers are documented accurately and in a timely manner.
- On a requested basis, review appeal cases and/or attend hearings to support utilization management determinations.
Requirements
- Qualifications 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, and the appropriate use of cardiac imaging modalities such as echocardiography, nuclear cardiology, cardiac CT, and cardiac MRI to support evidence-based medical necessity determinations Preferred
- 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, including
- experience with cost-benefit analysis, quality assurance, and continuous quality improvement processes To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID.
- 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.
- 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.
- experience required for the position and commensurate with
- experience of selected individuals, which may vary above and below the stated amounts.
Benefits
- 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.
- The expected base salary/wage range for this position is $96-$100/hr.
- As part of our total compensation package, Evolent is proud to offer comprehensive
- benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and
Contact
- If you need reasonable accommodation to access the information provided on this website, please contact recruitingteam@evolent.com for further assistance.
Additional details
- Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions.
- 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.
- What You’ll Be Doing: Job Description Summary As a IM-EM/Cardiology, Field Medical Director, you will serve as a key member of the Utilization Management team, providing timely, clinically sound medical reviews for cardiology-related service requests that do not initially meet applicable medical necessity guidelines.
- This role offers a meaningful opportunity to make a measurable difference in patients’ lives within a non-clinical environment, while supporting better health outcomes across member populations.
- This position promotes improved work–life balance and provides the opportunity to work on a collaborative team that values continuous learning, consistency in clinical decision-making, and professional engagement.
- The Field Medical Director routinely collaborates with physicians, clinical leadership, management staff, and other Field Medical Directors whenever specialty physician input is needed or required. Primary
- Responsibilities Serve as the specialty-match reviewer for diagnostic cardiology cases that do not initially meet applicable medical necessity guidelines, as well as other requests when providers, clients, or state regulations require specialty reviews to be completed by a cardiology subject matter expert.
- Provide clear, evidence-based clinical rationale for standard and expedited appeals.