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Medical Director of Utilization and Policy Development

2 weeks ago


Hartford, Connecticut, United States Evolent Full time
Clinical Leadership Opportunity in Evolving Healthcare Landscape

Evolent invites applications from highly skilled Medical Directors to join our team. The ideal candidate will possess excellent clinical acumen, strong leadership skills, and a deep understanding of the healthcare system.

The key responsibilities of this role include:

  • Maintaining open lines of communication with internal stakeholders, including leadership staff and physicians, to ensure seamless coordination of care.
  • Providing expert opinions on medical necessity for imaging cases that do not meet initial review criteria, using industry-standard guidelines and parameters.
  • Engaging in regular discussions with requesting physicians or ordering providers to clarify determinations and provide detailed clinical rationale for appeals.
  • Cultivating a culture of collaboration and continuous learning among team members, ensuring high-quality outcomes and efficient operations.
  • Leveraging extensive knowledge of medical review guidelines to promote consistency in decision-making and adherence to relevant regulations and standards.
  • Staying abreast of industry developments and best practices in utilization management, ensuring the organization remains at the forefront of innovation and excellence.

To be considered for this exciting opportunity, applicants should have:

  • MD/DO/MBBS degree
  • At least five years' experience in active clinical practice
  • Current, unrestricted clinical license in medicine or required specialty
  • Active Board Certification in Pulmonology
  • Demonstrated expertise in clinical leadership, management, and communication
  • A proven track record of promoting quality and value in healthcare