Field Medical Director Internal Medicine/ Emergency Medicine (Cardiology)

What You’ll Be DoingAs an IM-EM/Cardiology Field Medical Director, you will serve as a key member of the Utilization Management team, providing timely, clinically sound medical reviews for cardiology‑related service requests that do not initially meet applicable medical necessity guidelines. This role offers a meaningful opportunity to make a measurable difference in patients’ lives within a non‑clinical environment while supporting better health outcomes across member populations. Primary ResponsibilitiesServe as the specialty‑match reviewer for diagnostic cardiology cases that do not initially meet applicable medical necessity guidelines, and for other requests requiring specialty reviews. Review all cases in which clinical determinations cannot be made by Initial Clinical Reviewers, ensuring appropriate use of evidence‑based cardiology guidelines and regulatory standards. Provide clear, evidence‑based clinical rationale for standard and expedited appeals. Conduct peer‑to‑peer discussions with requesting physicians or ordering providers, within regulatory timeframes, via phone. Utilize medical and clinical review guidelines and parameters to ensure consistency in physician review processes and appropriate utilization, in alignment with SBU policies and procedures, URAC and NCQA standards. Assist and act as a clinical resource to Field Medical Directors and Initial Clinical Reviewers to discuss cases, address complex review scenarios, and support problem resolution. Ensure all communications with medical office staff and/or physician providers are documented accurately and in a timely manner. Participate in ongoing training initiatives, including inter‑rater reliability programs, to promote quality, consistency, and compliance. Assist the Senior Medical Director, as requested, with research activities and questions related to utilization management processes, guideline interpretation, and system or operational support. On a requested basis, review appeal cases and/or attend hearings to support utilization management determinations. On a requested basis, function as Medical Director for select health plans or regions, assuming overall accountability for utilization management activities in collaboration with the Senior Medical Director. Required QualificationsDO, MD, or MBBS degree from an accredited institution. Current Board Certification in Emergency Medicine or Internal Medicine by an American Certifying Board. Current, unrestricted medical license in one or more U.S. states. Demonstrated strong knowledge of diagnostic cardiology, including evaluation and management of cardiovascular conditions, and the appropriate use of cardiac imaging modalities such as echocardiography, nuclear cardiology, cardiac CT, and cardiac MRI to support evidence‑based medical necessity determinations. Preferred QualificationsFive (5) years of post‑residency clinical experience. Strong verbal and written communication skills, including the ability to effectively engage in peer‑to‑peer discussions with treating providers. Proficient computer skills and experience working with clinical review and documentation systems. Active clinical practice experience within the past 18 months. Familiarity with utilization management principles and procedures within managed care organizations, including experience with cost‑benefit analysis, quality assurance, and continuous quality improvement processes. Employment RequirementsTo ensure a secure hiring process we have implemented several identity verification steps, including submission of a government‑issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in‑person I‑9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical RequirementsAll employees must have the following technical capability at home: high‑speed internet over 10Mbps and, specifically for all call‑center employees, the ability to plug in directly to the home internet router. Compensation & BenefitsThe expected base salary/wage range for this position is $96–$100 per hour. As part of the total compensation package, Evolent is proud to offer comprehensive benefits, including health insurance benefits, to qualifying employees. All compensation determinations are based on the skills and experience required for the position and are commensurate with the experience of selected individuals, which may vary above and below the stated amounts. Equal Employment OpportunityEvolent 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. If you need reasonable accommodation to access the information provided on this website, please contact recruitingteam@evolent.com for further assistance.#J-18808-Ljbffr