Field Medical Director - Orthopedic Surgery Expert

Join Us to Transform Healthcare At Evolent, we collaborate with health plans and providers to improve outcomes for individuals facing complex and costly health challenges. Our mission is to bridge the gaps in the fragmented healthcare system, ensuring that every individual receivescompassionate and high-quality care. We prioritize work/life balance and offer flexible arrangements tailored to your unique needs. Our commitment to diversity and inclusion allows our employees to thrive and bring their authentic selves to work. Your Impact: As a Field Medical Director specializing in Musculoskeletal (MSK) Surgery, you will play a crucial role within our utilization management team, significantly impacting patient care in a supportive, non-clinical environment. Enjoy a healthy work-life balance while working alongside a dedicated team focused on continuous learning and enhanced health outcomes. Collaboration Opportunities: Engage regularly with leadership, management, physicians, and staff to provide essential clinical insights. Your Responsibilities Include: Reviewing Hip, Knee, and Shoulder Surgery cases that do not meet medical necessity guidelines and conducting specialty reviews for imaging requests. Facilitating peer-to-peer discussions with requesting physicians to clarify clinical rationale for appeal decisions. Applying medical review guidelines to ensure compliance with policies and URAC/NCQA standards. Acting as a resource for Initial Clinical Reviewers. Documenting all communications with medical office staff and providers accurately and promptly. Supporting the Senior Medical Director with inquiries related to the Utilization Management process. Participating in ongoing training to ensure inter-rater reliability. Qualifications: MD/DO/MBBS degree. A 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 relevant specialty. Active Board Certification in Orthopedic Surgery. Exceptional clinical, management, communication, and organizational skills. Commitment to quality and value in healthcare. Proficiency in computer systems. No exclusions or sanctions from 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 home, with specific requirements for call center roles to connect directly to the internet router. These requirements may change with the reopening of our office locations. Evolent is an equal opportunity employer, providing equal consideration to all applicants 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 performance-based bonus component. Evolent offers a comprehensive benefits package, including health insurance, to eligible 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 a suitable match arises!

Created: 2026-03-16