Otolaryngologist-Physician Reviewer-Field Medical Director, Radiology (Full-Time)

Currently seeking Otolaryngologist Physicians to join our Radiology department

As an FMD, Radiology you will be a key member of the utilization management team.

You will have the opportunity to make a meaningful impact on patient lives in a non‑clinical environment, while enjoying better work‑life balance on a collaborative team that values continuous learning and improved health outcomes.

• Collaboration Opportunities
• Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician’s input is needed or required.
• What You’ll Be Doing
• Serve as the Physician match reviewer in Imaging cases that do not initially meet the applicable medical necessity guidelines, and review other imaging requests when providers, clients, or state laws require specialty reviews.
• Discuss determinations (peer‑to‑peer phone calls) with requesting physicians or ordering providers within the regulatory timeframe of the request and provide clinical rationale for standard and expedited appeals.
• Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process, reflecting appropriate utilization and compliance with our policies and procedures, as well as URAC and NCQA guidelines.
• Aid and act as a resource to Initial Clinical Reviewers.
• Ensure documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• Assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
• Participate in ongoing training as part of the inter‑rater reliability process.

Qualifications

• MD/DO/MBBS.
• Minimum of five (5) years of experience in the practice of Medicine, post‑residency and active clinical practice within the last two years is preferred.
• Current, unrestricted clinical license in home state medicine or required specialty; maintaining medical licenses in the state of residence and any additional licenses required for business needs.
• Active Board Certification by an accredited organization.
• 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, including Medicare or Medicaid, and not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration, or reprimanded or sanctioned by Medicare.
• No history of a major disciplinary or legal action by a state medical board.

Evolent 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.

The expected base salary/wage range for this position is $95‑109/hr.

As part of our 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.

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