Your Future Evolves HerennEvolent 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.nnEvolent 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.nnJoin Evolent for the mission. Stay for the culture.nnWhat You’ll Be Doing:nnAs a Physician Clinical Reviewer 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.nnCollaboration Opportunities:nnRoutinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required.nnWhat You Will Be Doing:nnServe 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.nnDiscusses 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.nnUtilizes 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.nnAids and acts as a resource to Initial Clinical Reviewers.nnEnsures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.nnMay assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.nnParticipates in on-going training per inter-rater reliability process.nnQualifications - Required and Preferred:nnMD/DO/MBBS- RequirednnMinimum of five (5) years’ experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years- PreferrednnCurrent, unrestricted clinical license in medicine or required specialty- RequirednnObtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs- RequirednnActive Board Certification Urology (If a specialty or subspecialty, must also have that BC)- RequirednnStrong clinical, management, communication, and organizational skills- RequirednnEnergetic and curious with a passion for quality and value in health care- RequirednnComputer Proficiency- RequirednnNot 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.nnNo history of a major disciplinary or legal action by a state medical boardnnTechnical Requirements:nnWe 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.nnEvolent 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.nnThe expected base salary/wage range for this position is $95-110/hr. 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.nnDon'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!