Otolaryngologist-Physician Reviewer-Field Medical Director, Radiology (Full-Time)

at Evolent in Boise, Idaho, United States

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 theyre supported to live their best lives, and when they feel welcome to bring their whole selves to work. Thats one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What Youll Be Doing:

Currently seeking Otolaryngologist Physicians to join our Radiology department

As an 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.

What You Will Be Doing:

+ Serve as the Physician match reviewer in Imaging 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 res