Work in Iowa Veterans Jobs

Your Future Evolves Here

Evolent 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, RBM 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, Physicians, and staff whenever a physician`s input is needed or required. Strong partnership with Physician Business Managers to support the overall success of physician reviewers.

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 and reviews statistical sample of cases for physician reviewer 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 physician reviewer forums for education and question/issue resolution on a scheduled basis.

• In conjunction with management, measures physician reviewer productivity, quality, and telephone statistics.

• Provides direct guidance for improvement.

• Assists with new hire process.

• Attends training classes as needed for new hires to educate and train on Utilization management system and physician reviewer 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 physician reviewers.

• 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.

• 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:

• MD/DO/MBBS- Required

• Minimum of five (5) years’ experience in the practice of Medicine- Required

• Obtaining and maintaining active/unrestricted medical licenses in the state you reside, as well as, any license required per business needs- Required

• Active Board Certification in Radiology- 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 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 $215,000-$235,000. 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!