Oncology Physician Clinical Reviewer

What You’ll Be Doing

Lead the Transformation in Oncology Care
At Evolent, we’re redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal role in advancing value-based care models that prioritize clinical excellence, patient-centered outcomes, and system-wide impact. This role offers the opportunity to collaborate with top-tier clinicians, influence care pathways, and drive innovation in one of the most critical areas of health care.

If you're passionate about making a measurable difference in oncology, this is your platform to lead with purpose. In this role, you will combine your clinical oncology expertise with a focus on value-based strategy and transformation. Unlike traditional medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation.

Core Responsibilities

• Lead Clinical Review & Peer Collaboration

  • Serve as the physician reviewer for oncology cases that do not initially meet medical necessity criteria, applying evidence-based guidelines to ensure high-quality and cost-effective care.
  • Conduct peer-to-peer discussions with requesting oncologists—not only to explain determinations but to partner in driving practice patterns aligned with value and quality outcomes.
  • Support clinical reviewers as a subject matter expert and resource.

• Practice & Physician Engagement

  • Actively participate in engagement sessions with oncology practices, sharing best clinical practices and supporting broader adoption of evidence-based pathways.
  • Foster trusted peer relationships with oncologists to encourage sustainable behavior change that improves patient outcomes.
  • Support practice-level transformation initiatives that reduce unwarranted variation and enhance quality.

• Internal Strategy & Value Initiatives

  • Collaborate with Evolent’s clinical leadership on the design, build, and execution of new value initiatives in oncology.
  • Provide input on innovation opportunities, clinical algorithms, and models of care that support transformation in specialty care.
  • Partner with operational and analytic teams to assess the impact of interventions and identify opportunities for continuous improvement.
  • Participate in audit processes to validate accuracy of advance payment model payouts, ensuring alignment with clinical documentation, performance metrics, and contractual expectations.

• Compliance & Quality

  • Ensure all reviews and engagements align with URAC, NCQA, and internal quality standards.
  • Document peer interactions and clinical decisions in a timely and accurate manner.
  • Participate in training and inter-rater reliability processes.

Qualifications

• MD/DO/MBBS with board certification in Medical Oncology or Pediatric Oncology.

  • Minimum five (5) years’ post-residency experience, with active clinical practice preferred within the past 2 years.

• Current, unrestricted medical license (multiple state licenses preferred or willingness to obtain).

• Demonstrated leadership in practice transformation, value-based care, or clinical quality improvement.

• Strong communication, collaboration, and organizational skills, with proven ability to influence physician behavior.

• Energetic, curious, and passionate about shaping the future of oncology care delivery.

• Not under sanction or exclusion from Medicare/Medicaid programs.

Technical Requirements

• High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Benefits

• Comprehensive benefits (including health insurance benefits) to qualifying employees.

Pay

The expected base salary/wage range for this position is $130-$ 145/hr + potential sign on bonus.