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.
Evolent employees enjoy work/life balance, flexibility, and autonomy to complete their tasks. We believe people perform 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 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 when required by providers, clients, or state laws. Discuss determinations with requesting physicians or providers via peer-to-peer calls within the regulatory timeframe, providing clinical rationale for standard and expedited appeals. Use medical/clinical review guidelines to ensure consistency in review processes, reflecting appropriate utilization and compliance with policies, URAC, and NCQA guidelines. Assist and act as a resource to Initial Clinical Reviewers. Document all communications with medical staff or providers accurately and promptly. Support the Senior Medical Director with research related to Utilization Management, guidelines, or system support. Participate in ongoing training to ensure inter-rater reliability. Qualifications:
MD/DO/MBBS At least five years of medical practice experience, with recent clinical activity preferred Current, unrestricted medical license in the relevant specialty Active Board Certification in Medical Oncology Strong clinical, management, communication, and organizational skills Passion for quality and value in healthcare Proficiency with computer systems No current exclusions or sanctions from healthcare programs or agencies Additional Information: Identity verification may be required for HIPAA compliance during the application process. Home technical requirements include high-speed internet (>10 Mbps) and direct connection capability for call center roles. Evolent is an equal opportunity employer. Reasonable accommodations are available upon request. The salary range is $120-130/hr, plus potential bonuses and comprehensive benefits. If you do not see your ideal position listed, submit your contact info and resume for future consideration.
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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 when required by providers, clients, or state laws. Discuss determinations with requesting physicians or providers via peer-to-peer calls within the regulatory timeframe, providing clinical rationale for standard and expedited appeals. Use medical/clinical review guidelines to ensure consistency in review processes, reflecting appropriate utilization and compliance with policies, URAC, and NCQA guidelines. Assist and act as a resource to Initial Clinical Reviewers. Document all communications with medical staff or providers accurately and promptly. Support the Senior Medical Director with research related to Utilization Management, guidelines, or system support. Participate in ongoing training to ensure inter-rater reliability. Qualifications:
MD/DO/MBBS At least five years of medical practice experience, with recent clinical activity preferred Current, unrestricted medical license in the relevant specialty Active Board Certification in Medical Oncology Strong clinical, management, communication, and organizational skills Passion for quality and value in healthcare Proficiency with computer systems No current exclusions or sanctions from healthcare programs or agencies Additional Information: Identity verification may be required for HIPAA compliance during the application process. Home technical requirements include high-speed internet (>10 Mbps) and direct connection capability for call center roles. Evolent is an equal opportunity employer. Reasonable accommodations are available upon request. The salary range is $120-130/hr, plus potential bonuses and comprehensive benefits. If you do not see your ideal position listed, submit your contact info and resume for future consideration.
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