Job Description

Your Future Evolves Here

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

Evolent employees enjoy work/life balance, flexible schedules, and autonomy to accomplish their tasks. We believe people do their best work when supported to live their best lives and when they feel welcome to bring their whole selves to work. Diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What Youll Be Doing:

• Serve as the Physician match reviewer in Medical Oncology and imaging 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 with requesting physicians or providers via peer-to-peer calls within regulatory timeframes, providing clinical rationale for standard and expedited appeals.
• Utilize medical/clinical review guidelines to ensure consistency and compliance with policies, URAC, and NCQA standards.
• Assist and act as a resource to Initial Clinical Reviewers.
• Document all communications with medical staff and providers accurately and promptly.
• Support the Senior Medical Director in research activities related to Utilization Management.
• Participate in ongoing training to ensure inter-rater reliability.

Qualifications:

• MD/DO/MBBS
• Minimum five years of medical practice experience, with recent active clinical practice preferred
• Current, unrestricted medical license in your specialty
• Board certification in Medical Oncology
• Strong clinical, management, communication, and organizational skills
• Passion for quality and value in healthcare
• Computer proficiency
• No exclusion or sanction from federal or state healthcare programs
• No major disciplinary or legal actions against you

Additional Information:

Identity verification may be required to comply with HIPAA standards. Reasonable accommodations are available upon request. Technical requirements include high-speed internet (>10 Mbps) and direct connection capability for call center employees. Evolent is an equal opportunity employer. For accommodations, contact recruiting@evolent.com.

The position offers an expected base salary of $120-130/hr, plus performance-based bonuses and comprehensive benefits. Compensation depends on skills and experience.

If this isn't the right role, submit your contact info and resume, and we'll contact you if a suitable position arises.

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