Physician Reviewer-Radiology (Full-Time)

What You’ll Be Doing

As a FMD, Radiology 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.
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and 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.
• Sets ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
• Participates in on-going training per inter-rater reliability process.

Qualifications

• MD/DO/MBBS Minimum of five (5) years’ experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred
• Current, unrestricted clinical license in home state medicine or required specialty
• Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs
• Active Board Certification by an accredited organization
• Strong clinical, management, communication, and organizational skills
• Energetic and curious with a passion for quality and value in health care
• Computer Proficiency
• No history of a major disciplinary or legal action by a state medical board

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

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment.

Equal Opportunity Employer

We are an equal opportunity employer and consider all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Pay

The expected base salary/wage range for this position is $95-96/hr. 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.