Evolent
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 fragmented healthcare systems and ensure people receive the same level of care and compassion we would want for our loved ones.
Our employees enjoy work/life balance, flexibility, and autonomy. We believe people do their best work when supported to live their best lives and when they can bring their whole selves to work. Diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
What You’ll Be Doing:
Serve as the Physician match reviewer in Medical Oncology and imaging cases that do not initially meet medical necessity guidelines, as well as other imaging requests requiring specialty review by the subject matter expert. Discuss determinations with requesting physicians or providers via peer-to-peer calls within regulatory timeframes, providing clinical rationale for standard and expedited appeals. Use medical/clinical review guidelines to ensure consistency, appropriate utilization, and compliance with policies, URAC, and NCQA standards. Assist and act as a resource to Initial Clinical Reviewers. Document all communications with medical staff and providers accurately and promptly. Support the Senior Medical Director with research related to Utilization Management, interpretation, and system support. Participate in ongoing training to maintain inter-rater reliability. Qualifications:
MD/DO/MBBS Minimum five (5) years of clinical practice, with recent active practice preferred Current, unrestricted medical license in your specialty Board certification in Medical Oncology Strong clinical, management, communication, and organizational skills Passion for quality and value in healthcare Proficiency with computers No current exclusions or sanctions by health programs or agencies This role may require identity verification in compliance with HIPAA standards. Accommodations available upon request. Technical Requirements:
High-speed internet (>10 Mbps) and direct connection to the home router are required for remote work. Requirements may change with office reopenings. Evolent is an equal opportunity employer. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability.
For accommodations, contact recruiting@evolent.com. The base salary is $120-130/hr, with eligibility for performance-based bonuses and comprehensive benefits. Compensation varies based on skills and experience. If this isn’t the right job, submit your contact info and resume, and we’ll reach out if a suitable position opens.
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Serve as the Physician match reviewer in Medical Oncology and imaging cases that do not initially meet medical necessity guidelines, as well as other imaging requests requiring specialty review by the subject matter expert. Discuss determinations with requesting physicians or providers via peer-to-peer calls within regulatory timeframes, providing clinical rationale for standard and expedited appeals. Use medical/clinical review guidelines to ensure consistency, appropriate utilization, and compliance with policies, URAC, and NCQA standards. Assist and act as a resource to Initial Clinical Reviewers. Document all communications with medical staff and providers accurately and promptly. Support the Senior Medical Director with research related to Utilization Management, interpretation, and system support. Participate in ongoing training to maintain inter-rater reliability. Qualifications:
MD/DO/MBBS Minimum five (5) years of clinical practice, with recent active practice preferred Current, unrestricted medical license in your specialty Board certification in Medical Oncology Strong clinical, management, communication, and organizational skills Passion for quality and value in healthcare Proficiency with computers No current exclusions or sanctions by health programs or agencies This role may require identity verification in compliance with HIPAA standards. Accommodations available upon request. Technical Requirements:
High-speed internet (>10 Mbps) and direct connection to the home router are required for remote work. Requirements may change with office reopenings. Evolent is an equal opportunity employer. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability.
For accommodations, contact recruiting@evolent.com. The base salary is $120-130/hr, with eligibility for performance-based bonuses and comprehensive benefits. Compensation varies based on skills and experience. If this isn’t the right job, submit your contact info and resume, and we’ll reach out if a suitable position opens.
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