Field Medical Director, MSK (spine) (Atlanta)

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 care and compassion they deserve.

Evolent employees enjoy work/life balance, flexibility, and autonomy. We believe people perform their best work 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 values.

Join Evolent for the mission. Stay for the culture.

What Youll Be Doing:

As a Field Medical Director, MSK Surgery, you will review Spine Surgery cases as a specialty match reviewer. You will be a key member of the utilization management team, providing a meaningful way to make a difference in patients' lives in a non-clinical environment. Enjoy a better work-life balance on a collaborative, learning-focused team dedicated to improving health outcomes.

Collaboration Opportunities:

• Interact regularly with leadership, management, physicians, and staff as needed.

Key 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 standard and expedited appeals.
• Use medical review guidelines to ensure consistent, compliant reviews aligned with policies and accreditation standards.
• Support and serve as a resource to Initial Clinical Reviewers.
• Accurately document all communications with medical staff and providers.
• Participate in ongoing training for inter-rater reliability.
• Assist the Senior Medical Director with research related to utilization management and system support.
• Potentially serve as Medical Director for specific health plans or regions, overseeing utilization management in collaboration with senior leadership.

Qualifications - Required and Preferred:

• MD/DO/MBBS - Required
• At least five years experience in Spine Surgery - Preferred
• Current, unrestricted medical license in your specialty - Required
• Active medical licenses in your state - Required
• Board certification in Neurosurgery or Orthopedic Surgery - Required
• Strong clinical, management, communication, and organizational skills - Required
• Passion for quality and value in healthcare - Required
• Computer proficiency - Required

Additional Information:

Identity verification may be required for HIPAA compliance. Technical requirements include high-speed internet (>10 Mbps) and direct connection capability, subject to change.

Evolent is an equal opportunity employer. For accommodations, contact [email protected].

The salary range is not specified; compensation includes base salary, bonus potential, and benefits. If this role isn't a fit, submit your contact info and resume for future opportunities.