Field Medical Director Internal Medicine/ Emergency Medicine (Cardiology)

Your Future Evolves HereEvolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.Join Evolent for the mission. Stay for the culture.What You’ll Be Doing:Job Description SummaryAs a IM-EM/Cardiology, Field Medical Director, you will serve as a key member of the Utilization Management team, providing timely, clinically sound medical reviews for cardiology-related service requests that do not initially meet applicable medical necessity guidelines. This role offers a meaningful opportunity to make a measurable difference in patients’ lives within a non-clinical environment, while supporting better health outcomes across member populations.This position promotes improved work–life balance and provides the opportunity to work on a collaborative team that values continuous learning, consistency in clinical decision-making, and professional engagement.The Field Medical Director routinely collaborates with physicians, clinical leadership, management staff, and other Field Medical Directors whenever specialty physician input is needed or required.Primary ResponsibilitiesServe as the specialty-match reviewer for diagnostic cardiology cases that do not initially meet applicable medical necessity guidelines, as well as other requests when providers, clients, or state regulations require specialty reviews to be completed by a cardiology subject matter expert.Review all cases in which clinical determinations cannot be made by Initial Clinical Reviewers, ensuring appropriate use of evidence-based cardiology guidelines and regulatory standards.Provide clear, evidence-based clinical rationale for standard and expedited appeals.Conduct peer-to-peer discussions with requesting physicians or ordering providers, when available, within regulatory timeframes via phone.Utilize medical and clinical review guidelines and parameters to ensure consistency in physician review processes and appropriate utilization, in alignment with SBU policies and procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) standards.Assist and act as a clinical resource to Field Medical Directors and Initial Clinical Reviewers to discuss cases, address complex review scenarios, and support problem resolution.Ensure all communications with medical office staff and/or physician providers are docu...