Field Medical Director, Orthopedic Surgery

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for individuals with the most complex and costly health conditions. By working across specialties and primary care, we strive to bridge gaps in the fragmented healthcare system, ensuring that everyone receives the level of care and compassion we would want for our loved ones. At Evolent, we prioritize work/life balance, offering flexible arrangements that fit your life and the autonomy you need to succeed. We believe in supporting our employees to help them thrive and feel welcome in bringing their authentic selves to work, which is why diversity and inclusion are core to our values. Join us to contribute to our mission and be part of our vibrant culture. What You'll Be Doing: As a Field Medical Director in MSK Surgery, you will be an integral part of the utilization management team, making a significant difference in patients' lives in a supportive, non-clinical environment. Experience better work-life balance while collaborating with a team that values continuous learning and improved health outcomes. Collaboration Opportunities: Regularly engage with leadership, management, other Physicians, and staff to provide valuable clinical input as needed. Your Responsibilities Include: Serving as the Physician match reviewer for Hip, Knee, and Shoulder Surgery cases that do not initially meet medical necessity guidelines, along with other imaging requests when specialty reviews are required. Conducting peer-to-peer discussions with requesting physicians or providers to provide clinical rationale for appeal determinations. Utilizing medical review guidelines to ensure consistency and compliance with policies and URAC/NCQA standards. Acting as a resource for Initial Clinical Reviewers. Documenting all communications with medical office staff and/or MD providers accurately and promptly. Assisting the Senior Medical Director in research and inquiries related to the Utilization Management process. Participating in ongoing training to maintain inter-rater reliability. Qualifications: MD/DO/MBBS degree. Minimum of five years of post-residency experience in Medicine, with active clinical practice within the last two years preferred. Current, unrestricted clinical license in Medicine or the relevant specialty. Adept in maintaining necessary medical licenses as required. Active Board Certification in Orthopedic Surgery. Exceptional clinical, management, communication, and organizational skills. Enthusiastic and inquisitive with a commitment to quality and value in healthcare. Proficiency in computer systems. No exclusions or sanctions from any healthcare programs, including Medicare or Medicaid, and no major disciplinary actions by medical boards. To ensure a secure hiring process, we implement several identity verification measures, including submission of a government-issued photo ID. Comprehensive background checks and potential drug screenings will also be conducted prior to employment. Technical Requirements: All employees must have high-speed internet over 10 Mbps at their home, with specific requirements for call center roles to connect directly to the internet router. These requirements may change with any reopening of our office locations. Evolent is an equal opportunity employer, offering all applicants equal consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you require reasonable accommodation to access this information, please contact us for assistance. The expected base salary range for this position is $130-$150 per hour, with an additional bonus component based on performance factors. Evolent offers a comprehensive benefits package, including health insurance, to qualifying employees. All compensation decisions are based on the candidate's skills and experience. If you don’t see the job you’re looking for, please submit your contact information and resume, and we will reach out if we find a suitable match!

Created: 2026-03-04