Medical Director - Healthcare Utilization Specialist - Pierre - beBeeMedical Director

    beBeeMedical Director
    beBeeMedical Director Pierre

    1 week ago

    Job title: Field Medical Director, Pain Management

    Description

    Overview

    Evolent Health Opportunity

    We partner with health plans and providers to achieve better patient outcomes for individuals with complex and costly health conditions. Our approach connects the pieces of a fragmented healthcare system, ensuring patients receive consistent care and compassion.

    • We value work-life balance, flexibility, and autonomy in our employees' lives.

    Job Responsibilities


    As a Physician Clinical Reviewer for Interventional Pain Management, you will be an integral part of our utilization management team. Your responsibilities include:



    • Reviewing cases that do not meet medical necessity guidelines or other imaging requests requiring specialty reviews by subject matter experts;

    • Discussing determinations (peer-to-peer phone calls) with requesting physicians or ordering providers within regulatory timeframes;

    • Utilizing clinical review guidelines and parameters to ensure consistency in MD review processes reflecting appropriate utilization compliance with policies/procedures, URAC, and NCQA guidelines;


    • Benefits & Requirements


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