Remote MSK Orthopedic Surgery Field Medical Director

Evolent; Augusta (ME); Remote; USD 193,000 - 207,000; Full time

Benefits offered by this job

Health insurance

Job summary

Evolent is hiring a Field Medical Director for MSK Surgery to join the utilization management team in a non-clinical, remote-capable role. You will help review hip/knee/shoulder cases and guide clinical decisions, while collaborating with physicians and leadership to improve patient outcomes.

Requirements include MD/DO/MBBS, active orthopedic board certification, and a minimum of five years of practice with recent clinical activity.

Qualifications

• MD/DO/MBBS with current, unrestricted license in medicine or required specialty.
• Active Board Certification in Orthopedic Surgery.
• Minimum of five years’ clinical practice; recent active practice preferred.

Responsibilities

• Serve as the Physician match reviewer in hip/knee/shoulder surgery cases that do not meet medical necessity and other imaging reviews as required.
• Discuss determinations with requesting physicians within regulatory timeframes and provide clinical rationale for appeals.
• Utilize clinical review guidelines to ensure consistency with URAC/NCQA and internal policies.
• Aid and act as a resource to Initial Clinical Reviewers.
• Ensure timely, accurate documentation of all communications with medical staff.
• May assist the Senior Medical Director with research questions related to Utilization Management.
• Participate in ongoing training per inter-rater reliability processes.

Education

MD/DO/MBBS

Active Board Certification in Orthopedic Surgery

Tools

Computer Proficiency

Job description

Evolent is hiring a Field Medical Director for MSK Surgery to join the utilization management team in a non-clinical, remote-capable role. You will help review hip/knee/shoulder cases and guide clinical decisions, while collaborating with physicians and leadership to improve patient outcomes.

Requirements include MD/DO/MBBS, active orthopedic board certification, and a minimum of five years of practice with recent clinical activity.