MEDICAL DIRECTOR-MUSCULOSKELETAL
Company: Evolent Health
Location: Phoenix
Posted on: September 19, 2024
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Job Description:
Your Future Evolves HereEvolent partners with health plans and
providers to achieve better outcomes for people with most complex
and costly health conditions. Working across specialties and
primary care, we seek to connect the pieces of fragmented health
care system and ensure people get the same level of care and
compassion we would want for our loved ones.Evolent employees enjoy
work/life balance, the flexibility to suit their work to their
lives, and autonomy they need to get things done. We believe that
people do their best work when they're supported to live their best
lives, and when they feel welcome to bring their whole selves to
work. That's one reason why diversity and inclusion are core to our
business.Join Evolent for the mission. Stay for the culture.What
You'll Be Doing:As a Medical Director for the Musculoskeletal
department, 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 Medical Directors, and
health plan members and staff whenever a physician`s input is
needed or required. Responsible for acting as a clinical liaison to
providers and clients as directed by the office of the Chief
Medical Officer. While leading a team of Orthopedic and Spine
Surgeons.What You Will Be Doing:Provides medical direction to the
support services review process. Responsible for the quality of
utilization review determinations, including appeals.Provides input
into audit processes including development of questions.Reviews
statistical sample of cases for Field Medical Director audits and
makes recommendations into the types of cases to review.Responsible
to assist with all types of audits including Interrater, Customer,
Clinical quality, and/or confirmation of process changes.Holds
Field Medical Director forums for education and question/issue
resolution on a scheduled basis.In conjunction with other leaders,
measures Field Medical Director productivity, quality, and
telephone statisticsIn close partnership with Physician Business
Managers, provides coaching and guidance.Assists with new hire
process of Field Medical Directors.Attends training classes as
needed for new hires to educate and train on Utilization management
system and Field Medical Director process, standards and
resources.Acts as assigned mentor as needed for new hires and
completes new hire case assessment working on any defined areas of
opportunity.Assists with Hot Topic identification and content for
Field Medical Directors.Discusses determinations with requesting
physicians or ordering providers, when available, within the
regulatory timeframe of the request by phone or fax.Assists with
provider standards and expedited appeals.Actively participates in
identifying new concepts/projects with projected ROI impacts.On a
requested basis, reviews appeal cases and/or attends hearings for
discussion of utilization management decisions.Strong partnership
with Physician Business Managers to support the overall success of
Field Medical Directors.May function as Medical Director for select
health plans or regions, assuming overall accountability for
utilization management while working in conjunction with the SVP,
CCO and/or CMO.Additional duties as assigned.Qualifications -
Required and Preferred:Graduate of recognized medical degree
program- RequiredMinimum of five (5) years' experience in the
practice of Orthopedic Surgery- RequiredAt least two years of
experience in a leadership role- PreferredCurrent, unrestricted
state license- RequiredObtaining and maintaining medical licenses
in Required States- RequiredActive Board Certification in
Orthopedic Surgery - RequiredActive Board Certification in
Orthopedic Spine Surgery- PreferredStrong clinical, management,
communication, and organizational skills- RequiredEnergetic and
curious with a passion for quality and value in health care-
RequiredComputer Proficiency- RequiredTechnical 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 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 recruiting@evolent.com for further
assistance.The expected base salary/wage range for this position is
$$350,000. This position is also eligible for a bonus component
that would be dependent on pre-defined performance factors. 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
commensurate with experience of selected individuals, which may
vary above and below the stated amounts.Don't see the dream job you
are looking for? Drop off your contact information and resume and
we will reach out to you if we find the perfect fit!For more
insights about Evolent Health, click on Life At Evolent
(https://www.evolent.com/) to learn more!
Keywords: Evolent Health, Phoenix , MEDICAL DIRECTOR-MUSCULOSKELETAL, Executive , Phoenix, Arizona
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