Field Medical Director, MSK (spine) (Richmond)

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with complex and costly health conditions. Working across specialties and primary care, we aim to connect the fragmented healthcare system and ensure patients receive the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, flexible schedules, and autonomy to accomplish their goals. We believe people perform their best when supported to live their best lives and when they feel welcome to bring their whole selves to work. Diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What Youll Be Doing:

As a Field Medical Director, MSK Surgery, you will review Spine Surgery cases as a specialty match reviewer. You will be a key member of the utilization management team, providing a meaningful way to make a difference in patients' lives in a non-clinical environment. Enjoy better work-life balance on a team that values collaboration and continuous learning to improve health outcomes.

Collaboration Opportunities:

• Interact regularly with leadership, management staff, physicians, and other staff when their input is needed.

Responsibilities:

• Review Spine Surgery cases that do not initially meet medical necessity guidelines, including other imaging requests, when required by providers, clients, or laws.
• Discuss determinations with requesting physicians via peer-to-peer calls within regulatory timeframes.
• Provide clinical rationale for standard and expedited appeals.
• Use medical review guidelines to ensure consistency, appropriate utilization, and compliance with policies and accreditation standards.
• Support and serve as a resource to Initial Clinical Reviewers.
• Document all communications accurately and timely.
• Participate in ongoing training to maintain inter-rater reliability.
• Assist the Senior Medical Director with research related to utilization management and system support.
• Potentially serve as Medical Director for select health plans or regions, overseeing utilization management activities.

Qualifications - Required and Preferred:

• MD/DO/MBBS - Required
• Minimum five years of Spine Surgery practice - Preferred
• Current, unrestricted medical license in relevant specialty - Required
• Maintaining state medical licenses - Required
• Board certification in Neurosurgery or Orthopedic Surgery - Required
• Strong clinical, management, communication, and organizational skills - Required
• Energetic, curious, with a passion for quality healthcare - Required
• Proficiency with computers - Required

Additional Information:

Identity verification may be required for HIPAA compliance. Technical requirements include high-speed internet (>10 Mbps) and direct connection capabilities for call center employees. Evolent is an equal opportunity employer; accommodations are available upon request. Salary and benefits will be commensurate with experience. If this role isnt the right fit, submit your contact info and resume for future opportunities.