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Medical Director

1 week ago


Charleston, West Virginia, United States Evolent Full time

Evolent partners with health plans and providers to deliver high-quality care for patients with complex health conditions. As a Field Medical Director, you will be an integral part of our utilization management team, working across specialties to connect the pieces of the fragmented healthcare system.

Our employees enjoy work-life balance, flexibility, and autonomy to get things done. We believe in supporting people to live their best lives and feel welcome to bring their whole selves to work. Diversity and inclusion are core to our business.

We're seeking a motivated and compassionate medical professional to join our team. As a Field Medical Director, you will:

  • Routinely interact with leadership, physicians, and staff to provide input and expertise.

In addition to this role, you will:

  • Serve as a subject matter expert in reviewing imaging cases that don't meet medical necessity guidelines.
  • Discuss determinations with requesting physicians and provide clinical rationale for appeals.
  • Utilize medical review guidelines to ensure consistency in the MD review process.
  • Aid and act as a resource to initial clinical reviewers.
  • Ensure accurate documentation of all communications.
  • May assist the Senior Medical Director in research activities related to the Utilization Management process.
  • Participate in ongoing training per inter-rater reliability process.

To succeed in this role, you will need:

  • MD/DO/MBBS degree.
  • Minimum 5 years' experience in medicine, post-residency, and active clinical practice within the last 2 years.
  • Current, unrestricted clinical license in medicine or required specialty.
  • Active Board Certification as an Otolaryngologist.
  • Strong clinical, management, communication, and organizational skills.
  • Energetic and curious with a passion for quality and value in healthcare.