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Physician Clinical Reviewer- Physical Medicine and Rehabilitation

Company: Evolent Health
Location: Tallahassee
Posted on: September 19, 2023

Job Description:

Your Future Evolves Here
New Century Health (NCH) has been transforming the delivery of specialty care and driving radical cost and quality improvement across the member journey for patients with cancer and cardiovascular disease. As part of Evolent Health, we are on a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.
Why We're Worth the Application:

  • We continue to grow year over year.

  • Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .

  • Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index recognizing us as a best place to work for LGBTQ+ equality.

  • Named to Parity.org's list of the best companies for women to advance for 3 years in a row (https://www.evolenthealth.com/about-us/press-releases/9328/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2022) (2020, 2021 and 2022).

  • Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.

  • Publish an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we're building an equitable workplace.

    What You'll Be Doing:
    Do you crave an exciting new job that allows you to use your years of clinical expertise while developing new skills and improving the lives of others? If so, then this is the fit for you. As a Physician Clinical Reviewer, you'll use your clinical knowledge to provide evidence-based PMR reviews for patient care. You will be a key member of the utilization management team and routinely interact with physicians, leadership, management staff and other Physician Clinical Reviewers (PCR's) whenever a physician`s input is needed or required.
    We provide you with all the computer equipment and training needed to be successful in this role. And the best part, you get to reap the benefits of a work-from-home role. If you are looking for a better work life balance, we offer that at Evolent. We offer part-time and full-time roles, so that you can choose a schedule that works best for you!
    Job Summary:

    • Serve as the Clinical Reviewer for cases that do not initially meet the applicable medical necessity guidelines.

    • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.

    • 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.

    • Participates 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.

      The Experience You'll Need (Required):

      • DO/MD/MBBS Degree

      • Board Certified by and American Certifying Board for Physical Medicine and Rehabilitation

      • Current, Unrestricted License in one or more states

        Finishing Touches (Preferred):

        • 5 years post residency experience

        • Strong verbal communication skills

        • Good Computer Skills

        • Must have practiced clinical medicine in the last 18 months.

          Technical Requirements:
          We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, 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.
          Evolent Health 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.
          Compensation Range: The minimum salary for this position is $93.00, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.
          Don'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!
          For more insights about Evolent Health, click on Life At Evolent (https://www.evolenthealth.com/about-us/life-at-evolent) to learn more!

Keywords: Evolent Health, Tallahassee , Physician Clinical Reviewer- Physical Medicine and Rehabilitation, Healthcare , Tallahassee, Florida

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