Field Medical Director, MSK (Spine) Surgery

Evolent; Juneau (AK); Remote; USD 150,000 - 200,000; Full time

Job summary

Evolent is seeking a Field Medical Director for MSK Surgery to join their utilization management team. This role involves reviewing Spine Surgery cases and ensuring compliance with medical necessity guidelines. Candidates must hold an MD/DO and have a strong background in Spine Surgery, along with excellent clinical and management skills. The position offers work-life balance and the opportunity to make a meaningful impact in healthcare.

Benefits

Comprehensive health insurance

Work/life balance

Flexible work arrangements

Qualifications

• Minimum of five (5) years’ experience in Spine Surgery preferred.
• Current, unrestricted medical license in your specialty required.
• Passion for quality and value in healthcare required.

Responsibilities

• Serve as the specialty match reviewer in Spine Surgery cases.
• Discuss determinations with requesting physicians within regulatory timeframe.
• Provide clinical rationale for standard and expedited appeals.

Skills

Clinical skills

Management skills

Communication skills

Organizational skills

Computer proficiency

Education

MD/DO/MBBS

Active Board Certification in Neurosurgery or Orthopedic Surgery

Job description

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of a fragmented healthcare system and ensure people receive the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to tailor their work to their lives, and the autonomy needed 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 why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

As a Field Medical Director, MSK Surgery, you will be a specialty match reviewer for Spine Surgery cases. You will be a key member of the utilization management team. We offer a meaningful way to make a difference in patients' lives, in a non-clinical environment. Enjoy better work-life balance on a team that values collaboration and continuous learning while improving health outcomes.

Collaboration Opportunities:

• Routinely interacts with leadership, management staff, other physicians, and staff whenever a physician's input is needed or required.

What You Will Be Doing:

• Serve as the specialty match reviewer in Spine Surgery cases that do not initially meet medical necessity guidelines, as well as other imaging requests when required by providers, clients, or state laws.
• Discuss determinations (peer-to-peer phone calls) with requesting physicians or providers within the regulatory timeframe.
• Provide clinical rationale for standard and expedited appeals.
• Use medical/clinical review guidelines to ensure consistency and compliance with policies, URAC, and NCQA guidelines.
• Aid and act as a resource to Initial Clinical Reviewers.
• Ensure all communications with medical staff and providers are documented accurately and promptly.
• Participate in ongoing training per inter-rater reliability processes.
• Assist the Senior Medical Director with research related to utilization management, guidelines, and system support.
• On request, may serve as Medical Director for specific health plans or regions, overseeing utilization management in conjunction with the Senior Medical Director.

Qualifications - Required and Preferred:

• MD/DO/MBBS - Required
• Minimum of five (5) years’ experience in Spine Surgery - Preferred
• Current, unrestricted medical license in your specialty - Required
• License in your state of residence - Required
• Active Board Certification in Neurosurgery or Orthopedic Surgery - Required
• Strong clinical, management, communication, and organizational skills - Required
• Passion for quality and value in healthcare - Required
• Computer proficiency - Required

Technical Requirements:

All employees must have high-speed internet (>10 Mbps) at home and, for call center staff, the ability to connect directly to the home router. These requirements may change with office reopenings.

Evolent is an equal opportunity employer. If you need reasonable accommodations, contact [e-mail].

The expected base salary/wage range is $130-$150/hr, with potential bonuses based on performance. We offer comprehensive benefits, including health insurance. Compensation varies based on skills and experience.

Interested in other opportunities? Drop your contact info and resume, and we’ll reach out if a fit arises!