Your Future Evolves Here

As a Radiation Oncology, Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.

Collaboration Opportunities:

• Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. Aids and acts as a resource to Initial Clinical Reviewers.

What You Will Be Doing:

• Serve as the specialty match reviewer in Radiation Oncology and other Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
• 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.
• Provides clinical rationale for standard and expedited appeals.
• 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.
• 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. May assist the Senior Medical Director in research activities/questions.

Qualifications - Required and Preferred:

• MD/DO/MBBS- Required
• Minimum of five (5) years’ experience in the practice of Radiation Oncology- Preferred
• Current, unrestricted clinical license in medicine or required specialty- Required
• Obtaining and maintaining medical licenses in the state you reside- Required
• Active Board Certification in Radiation Oncology-Required
• Strong clinical, management, communication, and organizational skills-Required
• Energetic and curious with a passion for quality and value in health care-Required
• Computer Proficiency-Required

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 $100-$115/hr, 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.