现场医学总监，MSK外科
Field Medical Director, MSK Surgery
你的未来在这里不断进化
Evolent 与健康计划和医疗机构合作，为患有最复杂和昂贵健康状况的人群实现更好的结果。我们跨学科和基层医疗协作，致力于连接碎片化的医疗体系，确保人们获得与我们希望给亲人一样的护理水平和关怀。
Evolent 的员工享受工作与生活的平衡，能够根据自己的生活安排工作，并拥有完成任务所需的自主权。我们认为，当人们被支持去过最好的生活时，他们能发挥出最佳的工作表现，当他们感到欢迎带真实的自我来上班时也是如此。这也是为什么多样性和包容性是我们的业务核心原因之一。
加入 Evolent，为使命而来；留下，为文化而留。
你将从事的工作：
作为 Field Medical Director，MSK 外科，你将成为利用管理团队的关键成员。我们为你提供一种有意义的方式，在非临床环境中对患者的生活产生影响。你可以在一个重视协作和持续学习的团队中享受更好的工作与生活平衡，同时提供更好的健康结果。
协作机会：
· 经常与领导和管理人员、其他医生和员工互动，当需要或要求医生的意见时。
你将从事的工作：
- 在不符合适用医疗必要性指南的髋关节/膝关节/肩关节手术病例中，担任医生匹配审核员，以及当提供商、客户或州法律要求由专家完成专科审查时的其他影像请求。
- 在监管时限内，与请求医生或开单医生进行讨论（同行间电话沟通），并提供标准和加急申诉的临床依据。
- 使用医学/临床审查指南和参数，以确保 MD 审查过程的一致性，反映适当的利用情况和符合 SBU 的政策/程序，以及利用审查认证委员会（URAC）和国家质量保证委员会（NCQA）的指南。
- 为初始临床审查员提供帮助并作为资源。
- 确保与医疗办公室员工和/或 MD 提供商的所有沟通记录及时准确地进行记录。
- 可能协助高级医学总监进行与利用管理相关的研究活动/问题。
查看英文原文
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 Field Medical Director, MSK Surgery 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.
What You Will Be Doing:
- Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery 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 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.
- 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 highly preferred
- Current, unrestricted clinical license in 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 in Orthopedic Surgery
- Strong clinical, management, communication, and organizational skills
- Energetic and curious with a passion for quality and value in health care
- Computer Proficiency
- Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.
- No history of a major disciplinary or legal action by a state medical board
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. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.
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.
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 for further assistance.
The expected base salary/wage range for this position is $140-150/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.Originally posted on Himalayas