Field Medical Director, UM Physical Medicine

Your Future Evolves HereEvolent 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:Job DescriptionEvolent 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 ProgramsParticipate in the Appeals and Grievance process, as necessary, to assure timely and accurate responses to membersSupports design and implementation of health plan medical policies, and appropriate Care Management and UM goals and objectivesPopulation health – collaborative care management leadershipProvides 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 protocolsAssures 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 RGraduate 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.No history of a major disciplinary or legal action by a state medical boardTo ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. 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. Misrepresentation will result in immediate disqualification from consideration.Technical 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.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 recruitingteam@evolent.com for further assistance.The expected base salary/wage range for this position is $120-130. 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 experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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