Urology Physician Clinical Reviewer
3 weeks ago
Evolve Your Career with Evolent Health
Evolent Health partners with health plans and providers to deliver better health outcomes for individuals with complex and costly health conditions. As a Physician Clinical Reviewer, you will play a key role in our utilization management team, leveraging your medical expertise to ensure patients receive the best possible care.
About the Role
As a Physician Clinical Reviewer, you will be responsible for reviewing medical necessity guidelines and providing clinical rationale for standard and expedited appeals. You will work closely with leadership, management staff, and other physicians to ensure consistency in the MD review process and compliance with regulatory guidelines.
Key Responsibilities
Serve as the Physician match reviewer in Imaging cases that do not initially meet applicable medical necessity guidelines
Discuss determinations with requesting physicians or ordering providers via peer-to-peer phone calls within regulatory timeframes
Utilize medical/clinical review guidelines and parameters to ensure consistency in the MD review process
Requirements
MD/DO/MBBS degree required
Minimum 5 years' experience in medicine, post-residency, with active clinical practice within the last 2 years preferred
Current, unrestricted clinical license in medicine or required specialty required
Active Board Certification in Urology required
What We Offer
Evolent Health offers a competitive hourly rate of $95-110, with opportunities for bonuses based on performance. We also provide comprehensive benefits, including health insurance, to qualifying employees. If you are passionate about delivering high-quality healthcare and have a strong clinical background, we encourage you to apply for this exciting opportunity.
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