Field Medical Director, MSK (spine) (Little Rock)

Evolent Health Care Opportunity

Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. 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 Will Be Doing :

• Serve as the specialty match reviewer in Spine Surgery 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 with requesting physicians or ordering providers, when available, within the regulatory timeframe.
• 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 SBUs 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 provider is recorded in a timely and accurate manner.
• Participate in on-going training per inter-rater reliability process.
• Assist the Senior Medical Director in research activities / questions related to the Utilization Management process, interpretation, guidelines and / or system support.
• Function as Medical Director on a requested basis, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.

Qualifications - Required and Preferred :

To comply with HIPAA security standards, identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.

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.