Urology Physician Clinical Reviewer

3 weeks ago


Annapolis, Maryland, United States Evolent Health Full time

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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