Field Medical Director - Interventional Cardiology - Remote

About the role

This position centers on providing expert review for interventional cardiology cases within Evolent's Utilization Management team. The core responsibility involves evaluating cases that do not initially meet medical necessity guidelines, applying clinical expertise to ensure high-value, evidence-based care. This includes reviewing procedures like cardiac catheterizations, coronary interventions, and implantable cardiac devices, and offering guidance to initial clinical reviewers.

A key aspect of the role is conducting peer-to-peer discussions with treating physicians. These interactions aim to align care with clinical guidelines and facilitate appropriate decision-making. The director will also provide clinical rationale for appeals and ensure all communications and determinations are accurately documented within regulatory timeframes, contributing to compliance with URAC and NCQA guidelines.

Success in this role means consistently applying medical/clinical review guidelines to ensure appropriate utilization and compliance. The individual will collaborate with leadership and clinical staff on complex cases and may assist the Senior Medical Director with research related to utilization management processes. There's also potential to function as a Medical Director for specific health plans or regions, overseeing utilization management.

The salary for this full-time senior role ranges from $69,000 to $115,000 annually.

Skills that matter here

• Interventional Cardiology: This role requires deep expertise in interventional cardiology to review complex cardiovascular cases and provide specialty-matched expert opinions.
• MD/DO/MBBS Degree: A medical degree is a fundamental requirement, enabling the director to perform expert clinical reviews and engage in peer-to-peer discussions.
• Current, unrestricted clinical license in medicine or required specialty: Maintaining an active medical license is essential for legal and ethical practice, as well as obtaining additional state licenses as business needs dictate.
• Board Certification in Interventional Cardiology: Board certification or equivalent experience in interventional cardiology is necessary to serve as a credible expert reviewer and guide clinical decision-making.
• Strong clinical, management, communication, and organizational skills: These skills are vital for conducting effective peer-to-peer discussions, collaborating with leadership, and managing case reviews efficiently.
• Computer Proficiency: Proficiency with computers is needed for documenting communications, case reviews, and potentially assisting with research activities.

Who this role suits

• Someone who thrives on applying their interventional cardiology expertise in a non-clinical, review-focused setting.
• A medical professional who values work-life balance and a flexible schedule, while still contributing meaningfully to patient care.
• An individual who is detail-oriented, passionate about quality healthcare, and adept at communicating complex clinical rationales to peers.
• A collaborative team member who can guide other clinical staff and work effectively with leadership on complex cases.

From the employer

What You’ll Do

• Provide expert reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (e.g., cardiac catheterizations, coronary interventions, endovascular procedures, implantable cardiac devices, etc) that do not initially meet medical necessity guidelines or require further evaluation by a subject matter expert.
• Conduct peer-to-peer discussions with treating providers to ensure appropriate, high-value care aligned with clinical guidelines.
• Collaborate with leadership, management, and clinical staff to address complex cases and support decision-making.
• Act as a key resource for Initial Clinical Reviewers, offering guidance and expertise to ensure the application of best practices.
• Provide clinical rationale for standard and expedited appeals.
• Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
• Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with URAC and NCQA guidelines.
• Ensure documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• Participate in on-going training per inter-rater reliability process.
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
• On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.

Qualifications

• MD/DO/MBBS Degree
• Current, unrestricted clinical license in medicine or required specialty
• Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs
• Active Board Certification in Interventional Cardiology or may be substituted for one of the following:
• Active Board Certification in Cardiology and proof of prior board certification in Interventional Cardiology
• Active Board Certification in Cardiology and proof of active practice as an Interventional Cardiologist for 5+ years
• Strong clinical, management, communication, and organizational skills
• Energetic and curious with a passion for quality and value in health care
• Computer Proficiency
• Minimum of five (5) years’ experience in the practice of Cardiology is preferred
• Not under current exclusion or sanction by any state or federal health care program, and not identified as an “excluded person” by OIG or GSA, or reprimanded or sanctioned by Medicare.
• No history of a major disciplinary or legal action by a state medical board.

What We Offer

• A meaningful way to contribute to patient care beyond the clinical setting.
• Opportunities for collaboration with a dynamic team of physicians, leaders, and clinical professionals.
• A role that values innovation, continuous improvement, and clinical excellence.
• This position is 100% Remote and can be completed from any state. Multiple opportunities for a flexible schedule and both part-time and full-time options available.