Remote MSK Orthopedic Field Medical Director

Evolent; Carson City (NV); Remoto; USD 193.000 - 207.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

Comprehensive benefits package

Remote work

Descrizione del lavoro

Evolent is seeking a Field Medical Director for MSK Surgery to join the utilization management team in a non-clinical environment. This role offers better work-life balance and collaboration across departments, with autonomy to get things done.

You will review hip/knee/shoulder surgery cases, discuss determinations with physicians within regulatory timeframes, and ensure documentation complies with URAC and NCQA guidelines.

Competenze

• MD/DO/MBBS degree.
• Current, unrestricted clinical license in medicine or required specialty.
• Active Board Certification in Orthopedic Surgery.
• Minimum of five years’ medical practice experience.
• No exclusions on government health programs.

Mansioni

• Serve as the physician match reviewer in hip/knee/shoulder surgery cases requiring specialty review.
• Discuss determinations with requesting physicians within regulatory timeframes and provide clinical rationale.
• Apply URAC/NCQA guidelines to ensure consistency in reviews.
• Assist Initial Clinical Reviewers as needed.
• Document all communications with medical staff in a timely, accurate manner.
• Support Senior Medical Director with research questions related to Utilization Management.
• Participate in ongoing training per inter-rater reliability process.

Conoscenze

Orthopedic surgery

Clinical experience

Communication skills

Formazione

MD/DO/MBBS

Active medical license

Descrizione del lavoro

Evolent is seeking a Field Medical Director for MSK Surgery to join the utilization management team in a non-clinical environment. This role offers better work-life balance and collaboration across departments, with autonomy to get things done.

You will review hip/knee/shoulder surgery cases, discuss determinations with physicians within regulatory timeframes, and ensure documentation complies with URAC and NCQA guidelines.