Cardiology Physician Clinical Review Specialist
3 weeks ago
About the Role:
Evolent Health is seeking a highly skilled Cardiology Physician Clinical Reviewer to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that patients receive the best possible care.
Key Responsibilities:
- Serve as the specialty match reviewer in Cardiology cases that do not initially meet the applicable medical necessity guidelines.
- Provide clinical rationale for standard and expedited appeals.
- Discuss determinations with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
- Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process.
- Ensure documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
- Participate in on-going training per inter-rater reliability process.
- May assist the Senior Medical Director in research activities/questions related to the Utilization Management process.
Requirements:
- MD/DO/MBBS Degree
- Current, unrestricted clinical license in medicine or required specialty
- Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease
- Strong clinical, management, communication, and organizational skills
- Energetic and curious with a passion for quality and value in health care
- Computer Proficiency
- Minimum of five (5) years' experience in the practice of Cardiology
About Evolent Health:
Evolent Health is a health care company that partners with health plans and providers to achieve better outcomes for people with complex and costly health conditions. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work.
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