Cardiology Physician Clinical Review Specialist

3 weeks ago


Columbus, Ohio, United States Evolent Health Full time

Evolent Health seeks a 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 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.

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

What We Offer:

  • A competitive hourly rate of $115-$130
  • A bonus component based on pre-defined performance factors
  • Comprehensive benefits, including health insurance benefits

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.



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