Your Future Evolves Here

Do you crave an exciting new job that allows you to use your years of clinical expertise while developing new skills and improving the lives of others? If so, then this is the fit for you. As a Physician Clinical Reviewer, you’ll use your clinical knowledge to provide evidence-based PMR reviews for patient care. You will be a key member of the utilization management team and routinely interact with physicians, leadership, management staff and other Physician Clinical Reviewers (PCR’s) whenever a physician`s input is needed or required.

We provide you with all the computer equipment and training needed to be successful in this role. And the best part, you get to reap the benefits of a work-from-home role. If you are looking for a better work life balance, we offer that at Evolent. We offer part-time and full-time roles, so that you can choose a schedule that works best for you!

Job Summary:

• Serve as the Clinical Reviewer for cases that do not initially meet the applicable medical necessity guidelines.
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
• Provides clinical rationale for standard and expedited appeals.
• Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
• Aids and acts as a resource to Initial Clinical Reviewers.
• Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• Participates in on-going training per inter-rater reliability process.
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
• On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.
  

The Experience You’ll Need (Required):

• DO/MD/MBBS Degree
• Board Certified by and American Certifying Board for Physical Medicine and Rehabilitation
• Current, Unrestricted License in one or more states

Finishing Touches (Preferred):

• 5 years post residency experience
• Strong verbal communication skills
• Good Computer Skills
• Must have practiced clinical medicine in the last 18 months.

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health 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.

Compensation Range: The minimum salary for this position is $93.00, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.