Field Medical Director, MSK Surgery (Orthopedic Surgery)

Evolent partners with health plans and providers to achieve better outcomes for patients with complex and costly health conditions. ResponsibilitiesServe as the Physician match reviewer for Hip/Knee/Shoulder surgery cases that do not initially meet applicable medical necessity guidelines, and for other imaging requests requiring specialty review. Discuss determinations via peer‑to‑peer phone calls with requesting physicians or ordering providers, providing clinical rationale for standard and expedited appeals within the required regulatory timeframe. Utilize medical/clinical review guidelines and parameters to ensure consistency in the doctor review process, reflecting appropriate utilization and compliance with SBU policies, URAC and NCQA guidelines. Act as a resource and aid to Initial Clinical Reviewers. Ensure documentation of all communications with medical office staff or MD providers is recorded in a timely and accurate manner. Assist the Senior Medical Director in research activities or questions related to the Utilization Management process, interpretation, guidelines, and system support. Participate in ongoing training as required by the inter‑rater reliability process. Routinely interact with leadership, management staff, other physicians, and support staff whenever physician input is needed or required. QualificationsMD/DO/MBBS with an active clinical license in good standing in your home state. Minimum five (5) years of post‑residency medical practice experience, with active clinical practice within the last two years preferred. Current unrestricted clinical license in medicine or the required specialty. Active board certification in Orthopedic Surgery. Strong clinical, management, communication, and organizational skills. Energetic and curious with a passion for quality and value in health care. Computer proficiency. Not under current exclusion or sanction by any state or federal health‑care program, and no history of major disciplinary or legal action by a state medical board. Compensation & BenefitsBase salary range: $135–$150 per hour. Comprehensive benefits package, including health insurance benefits. High‑speed internet connection (≥10Mbps) required for home‑based duties. Equal Employment Opportunity StatementEvolent 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.#J-18808-Ljbffr