Field Medical Director, UM Physical Medicine

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 1,001-5,000H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

84 days ago

Salary

$120K - $130K / year

Seniority

Lead

No structured requirement data.

Job Description

Field Medical Director, UM Physical Medicine

Evolent

Your Future Evolves Here Evolent 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 Evolent is looking for a Field Medical Director to be a member of the Evolent clinical team. As a collaborative member of a team of clinicians, physicians, pharmacists, health economists, and program coordinators, you will have the opportunity to make a profound impact on the lives of our members. Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers. What you’ll be doing: - Supports pre-admission review, utilization management, and concurrent and retrospective review process. - Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs, - Assists with execution of Evolent's benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs - Participate in the Appeals and Grievance process, as necessary, to assure timely and accurate responses to members - Supports design and implementation of health plan medical policies, and appropriate Care Management and UM goals and objectives - Population health – collaborative care management leadership - Provides clinical leadership and development for population health programs or functional areas within Medical Management. - Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population. - Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers. - Participate in committees as assigned. - Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care. - Evaluates and ensures systems and processes to assist providers with adherence to evidence based protocols - Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations. Qualifications: - Active Board Certification by an American Certifying Board (If a specialty or subspecialty, must have that BC) - 1+ years of Utilization Review Experience R - Graduate of an accredited medical school. Either MD or DO degree is required. - Active physician license without any restrictions. - 3-5 years of clinical practice in a primary care setting and progressively responsible medical administrative experience preferred. - Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder. - A thorough understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts. - Excellent interpersonal, verbal, and written communication skills. - Consistently completes continuing education activities relevant to practice area and needed to maintain licensure. - Ability to navigate in a corporate matrix environment is preferred. - Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. - No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. Evolent 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. If you need reasonable accommodation to access the information provided on this website, please contact recruitingteam@evolent.com for further assistance. The expected base salary/wage range for this position is $120-130. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

Related Categories

Related Job Pages

More Medical Director Jobs

Understood Care logo

Telehealth Physician (Remote)

Understood Care

Patient Advocacy to Help You Get the Best Care You Deserve - Covered by Medicare.

Medical Director84 days ago
Full TimeRemoteTeam 11-50Since 2025

Telehealth Physician - Remote At Understood Care, our mission is to bridge the healthcare gap for Medicare patients who would like some help navigating the complex healthcare system. Understood Care matches Medicare patients with an assistant with healthcare expertise (known as a Patient Advocate). Patient Advocates help patients with anything patients need in order to access care - booking appointments, finding transportation, ordering medical equipment and much more. The role: In this position, you will conduct audio or video patient intake appointments, which is a 20-30 minute appointment to understand the challenges that the patient is facing. You will determine if a patient is suited to receive patient advocacy under the principals of Principal Illness Navigation and/or Community Health Integration. This role does not require diagnosing or prescribing. You will also collaborate closely with our technology team to develop innovative AI tools that enhance the clinical experience. We are seeking a physician who is passionate about improving care access for the Medicare population and is excited to work at an early stage startup. Responsibilities: - Thrives in a fast-paced, startup environment - Cares deeply about medicare aged patients and patient advocacy - Prior experience working with Medicare patients - Very well versed in technology and can learn new technologies quickly - prior experience delivering care via Telehealth is a plus - Positive attitude and bias towards action - Strong communication and interpersonal skills Qualifications: - Board certification in family medicine or internal medicine - Active member of an IMLC state and open to acquiring additional licensure. IMLC member states are AL, AZ, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, MT, NE, NV, NH, NJ, ND, OH, OK, PA, SD, TN, TX, UT, VT, WA, WV, WI, WY, GU - PTAN/PECOS account (registration and enrollment with Medicare) Role: This is a remote, part-time role with the ability to evolve into a full time role. We would prefer a minimum of 10 hours a week, though week to week availability is flexible. Compensation: Rate: $125/hour.

Worldwide
Acentra Health, LLC logo

Associate Medical Director

Acentra Health, LLC

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Medical Director84 days ago
Full TimeRemoteTeam 1,001-5,000

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities The Associate Medical Director will engage medical activities like peer review, of medical prior authorizations, peer-to-peer conversations, testimony on behalf of Health First Colorado during Medicaid Fair Hearings, and other clinical consultations related to the applicable contract. The Associate Medical Director may also support business development and strategic planning as needed. (This is a part-time position ~ 20 hours per week) - Responsible for day-to-day clinical decision-making aspects of the Utilization Management program and provides clinical guidance to clinical review team members. - Collaborate with other Medical Directors on case consultations as needed. - Discuss complicated Utilization Management reviews or clinical scenarios with Utilization Management Clinical Reviewers. - Participate in the client's weekly, monthly, quarterly and ad-hoc medical meetings. - Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy. - Conduct educational meetings twice a year for Clinical Review staff on relevant clinical topics of interest. - Complete secondary-level Utilization Management reviews including peer-to-peer and reconsideration UM reviews. - Prepare for and attend by video conference assigned Medicaid Fair Hearings defending the determinations made by the Company on behalf of Health First Colorado. - Participate in annual and ad hoc review of clinical medical necessity criteria consistent with clinical expertise. - Perform any other duties assigned. Qualifications Required - M.D. or D.O. with a current non-restricted license to practice medicine by the Board of Medical Examiners. - Board certification in a clinical specialty is required. - 10+ years of active practice preferred; 5 years minimum required. - 5-7 years of experience in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues. - Experience in Utilization Management with knowledge of Medicaid and Medicare programs. - Exceptional writing and oral communication abilities. - Strong knowledge of quality assurance and utilization review. Preferred: - 2 years as a Medical Director in a managed care company or health plan preferred. - Prior review experience or quality assurance committee responsibility in a hospital setting is preferred. - Proficient in Microsoft Excel and other Microsoft Office applications. - Exceptional writing and oral communication abilities. - Strong knowledge of quality assurance and utilization review. - Understand significant trends in healthcare and managed care. - Ability to work effectively with a diversity of personalities. - Ability to be approachable, show respect for others and be a consensus builder. - Strong organizational skills and a system thinking approach. - Ability to efficiently manage projects. - Ability to deliver on time and within budget. - Adaptable with a collaborative solid management style. - Ability to be a creative thinker. - Possess high energy and enthusiasm. - Able to adapt to frequently changing work parameters. Pay Range USD $187,520.00 - USD $90.15 /Hr.

United States
$90 - $187.5K / hour
Mednet logo

Medical Director – Oncology

Mednet

Easily build and manage your own studies with Mednet’s clinical data management system for all study types and phases.

Medical Director84 days ago
Full TimeRemoteTeam 51-200H1B Sponsor

• Manage a team of physician editors in Medical Oncology, Radiation Oncology, Hematology, Pediatric Hematology/Oncology, and Gynecologic Oncology, under the guidance of the Senior Medical Director of Oncology • Launch and manage Palliative Medicine specialty • Oversee content, engagement, and growth in oncology specialties • Work with product team to give input on new products and improving products offered to physicians on Mednet • Grow relationships with oncology professional societies and academic programs

United States
Genentech logo

Senior Director, Medical Learning Leader

Genentech

Genentech is an equal opportunity employer. It is our policy and practice to employ, promote, and otherwise treat any and all employees and applicants on the basis of merit, qualifications, and competence. The company's policy prohibits unlawful discrimination, including but not limited to, discrimination on the basis of Protected Veteran status, individuals with disabilities status, and consistent with all federal, state, or local laws. If you have a disability and need an accommodation in relation to the online application process, please contact us by completing this form.

Medical Director84 days ago
Full TimeRemoteTeam 10,001

The Position The Opportunity The Senior Director of Medical Learning acts as the primary strategist for the clinical readiness of Genentech's entire medical organization. The role ensures both home office and field medical teams possess the scientific acumen and digital fluency needed for the "omnichannel pharma" era, championing a continuous learning culture. Key responsibilities include designing compliant curriculum, overseeing a comprehensive learning strategy aligned with the US Medical strategy, and spearheading the field medical onboarding experience. This leader manages the ongoing development journey for the Medical organization, leading a team of Field Training Partners & Squad Trainers and using strategic workforce planning data to prioritize critical skills. The role drives innovation by continuously measuring the learning experience for all employees and integrating digital learning solutions, while collaborating cross-functionally with teams like Marketing, Compliance, and People & Culture. Key Accountabilities - Strategic Leadership and Integration: Serve as the single-threaded leader accountable for the comprehensive training and readiness of all field and home office medical employees, setting strategic direction and ensuring clinical capability development is linked to the organization's long-term imperatives, driving measurable business impact and omnichannel excellence through consulting with Medical and Commercial teams. - Learning Strategy and Execution: Define and lead a multi-year learning roadmap that accelerates the US Medical (USM) strategy, directing a team of partners and trainers to develop clear onboarding frameworks and continually optimizing the new hire and annual field medical learning experience for rapid role proficiency. - Field Readiness and Scalable Infrastructure: Lead senior employees in providing deep technical expertise on Genentech’s portfolio and the healthcare landscape, while directing an ecosystem of learning partners, architects, and technologists to deliver high-fidelity learning products at scale and managing field meeting learning components. - Data, Measurement, and Compliance: Utilize strategic workforce planning data to anticipate and address future skill gaps, partner with Data Science to automate metrics, move toward business impact metrics (Value Realization), and serve as the primary point of contact for internal and external audits and compliance oversight. - Team and Employee Focus: Cultivate a culture of belonging and influence across complex, matrixed dynamics (Governance & Influence) while leading and guiding the team to execute high-quality training, overseeing the development journey (Employee Experience), and collaborating closely with cross-functional partners like Compliance, Marketing, and People & Culture. Management Responsibilities: - Develop and create an inspiring culture and great place to work by leading, acting and living our Operating Principles in all aspects of work, inclusive of employee engagement and promoting a culture of inclusivity and belonging - Responsible for resource management, recruiting, hiring, on-boarding, managing, and leading teams in assigned functional areas through operations strategy, strategic alignment with internal stakeholders, and understanding current and future business needs. - Establishes and clearly communicates team priorities, goals and expectations - Foster collaboration across multiple functions within LSD, CMG, and Genentech to drive alignment and ensure effective implementation of learning solutions - Provide clear direction and focus for the team while ensuring all deliverables for a given priority area are completed, issues are escalated and assess/mitigate risk appropriately - Manage resources in an out of key initiatives as needed to flow talent, ensure ongoing maintenance, drive critical work and assess/mitigate risk Who you are: - You have an advanced clinical degree required (PharmD, MD, PhD, or equivalent) - You have 12+ years in a senior leadership (Director or above) role managing and leading large, diverse teams (including direct and indirect reports) responsible for training delivery and strategy. - Proven experience as a strategic business partner to senior leadership teams. - Demonstrated success in designing, implementing, and optimizing large-scale field employee onboarding programs. - Deep working knowledge of the pharmaceutical/biotech field medical roles (e.g. Medical Science Liaisons) and their compliance requirements. - Extensive experience in product launch training, field readiness, and developing learning strategies for complex therapeutic areas and product portfolios. - Proven ability to leverage AI, technology, data and analytics (e.g., learning KPIs, proficiency metrics, strategic workforce planning data) to drive development strategy and measure business impact. Relocation Benefits are not offered on this posting This role is South San Francisco, CA preferred however is Remote approved The expected salary range for this position based on the primary location of California is $185,700/yr to $345,000/yr. Actual pay will be determined based on experience, qualifications, geographic location, and other job-related factors permitted by law. A discretionary annual bonus may be available based on individual and Company performance. This position also qualifies for the benefits detailed at the link provided below. Benefits #LI-CM4 JA Genentech is an equal opportunity employer. It is our policy and practice to employ, promote, and otherwise treat any and all employees and applicants on the basis of merit, qualifications, and competence. The company's policy prohibits unlawful discrimination, including but not limited to, discrimination on the basis of Protected Veteran status, individuals with disabilities status, and consistent with all federal, state, or local laws. If you have a disability and need an accommodation in relation to the online application process, please contact us by completing this form Accommodations for Applicants.

United States
$185K - $345K / year