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Medical Director for Specialty Care

1 week ago


Hartford, Connecticut, United States Evolent Full time
Transforming Healthcare Delivery

Evolent partners with health plans and providers to drive better outcomes for individuals with complex health conditions. By connecting specialists and primary care teams, we strive to ensure people receive the same level of care and compassion as we would want for our loved ones.

At Evolent, we prioritize work-life balance, flexibility, and autonomy. We believe that when employees feel supported to live their best lives, they do their best work. Diversity and inclusion are core to our business, fostering a culture where everyone feels welcome to bring their whole selves to work.

We're looking for a seasoned physician leader to join our utilization management team as a Field Medical Director. This role offers a meaningful way to make a difference in patients' lives without direct clinical involvement.

Key Responsibilities:
  • Serve as the primary reviewer for Imaging cases not meeting initial medical necessity guidelines.
  • Discuss determinations with requesting physicians or ordering providers, ensuring timely peer-to-peer phone calls within regulatory requirements.
  • Utilize medical review guidelines to maintain consistency in the MD review process.
  • Support Initial Clinical Reviewers by providing guidance and resources.
  • Document all communications with medical office staff and/or MD providers in a timely and accurate manner.
  • Collaborate with the Senior Medical Director on research activities related to Utilization Management.
  • Participate in ongoing training per inter-rater reliability processes.