Field Medical Director, MSK (spine) (Columbus)

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with complex and costly health conditions. Working across specialties and primary care, we aim to connect fragmented healthcare systems and ensure people receive the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, flexible schedules, and autonomy to complete their tasks. We believe people perform their best when supported to live their best lives and when they feel welcome to bring their whole selves to work. Diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What Youll Be Doing:

As a Field Medical Director, MSK Surgery, you will serve as a specialty match reviewer for Spine Surgery cases and be a key member of the utilization management team. This role offers a meaningful way to make a difference in patients' lives in a non-clinical environment, with better work-life balance, collaboration, and ongoing learning.

Collaboration Opportunities:

• Interact routinely with leadership, management staff, physicians, and staff for input and requirements.

Responsibilities:

• Review Spine Surgery cases that do not initially meet medical necessity guidelines, including other imaging requests, when required by providers, clients, or laws.
• Discuss determinations with requesting physicians within regulatory timeframes.
• Provide clinical rationale for appeals.
• Use medical review guidelines to ensure consistency, compliance, and quality standards.
• Support and serve as a resource to initial clinical reviewers.
• Document all communications accurately and timely.
• Participate in ongoing training and quality assurance activities.
• Assist in research activities related to utilization management and guidelines.
• Potentially serve as Medical Director for specific health plans or regions, overseeing utilization management.

Qualifications - Required and Preferred:

• MD/DO/MBBS - Required
• Minimum five years experience in Spine Surgery - Preferred
• Unrestricted medical license in your state - Required
• Active Board Certification in Neurosurgery or Orthopedic Surgery - Required
• Strong clinical, management, communication, and organizational skills - Required
• Passion for quality and value in healthcare - Required
• Proficiency with computers - Required

Additional Information:

Identity verification may be required for HIPAA compliance. Technical requirements include high-speed internet (>10 Mbps) and direct connection capability for call center employees. Evolent is an equal opportunity employer and provides accommodations upon request. Compensation includes base salary, potential bonuses, and comprehensive benefits.

If this role isn't the perfect fit, submit your contact info and resume for future opportunities.