Psychiatry- Field Medical Director

Evolent Health • Montpelier, VT, United States • $200k - $250k / year • 1m ago

Evolent Health - Psychiatry Field Medical Director - Montpelier, Vermont

Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of the 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 the 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:

As a Behavioral Health Field Medical Director, you will be a key member of the utilization management team, offering a meaningful way to make a difference in patients' lives in a non-clinical environment.
Support pre-admission review, utilization management, and concurrent and retrospective review processes.
Participate in risk management, claim adjudication, pharmacy utilization management, and catastrophic case review.
Assist with the execution of Evolent's benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs.
Participate in the Appeals and Grievance process to assure timely and accurate responses to members.
Support the design and implementation of health plan medical policies and appropriate Care Management and UM goals and objectives.
Provide clinical leadership and development for population health programs or functional areas within Medical Management.
Assist in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
Promote 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.
Provide guidance and interpretation on issues of medical appropriateness, benefit application, and level of care necessary, including out-of-network care.
Evaluate and ensure systems and processes to assist providers with adherence to evidence-based protocols.
Assure compliance related to Federal (e.g., CMS), State (e.g., Insurance commission), and local rules and regulations.

Qualifications:

Board Certification in Psychiatry.
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 a 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.

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. These at-home technical requirements are subject to change with any scheduled reopening of our office locations.

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.

The expected base salary/wage range for this position is $120-130/hr. This position is also eligible for a bonus component that would be dependent on predefined performance factors. 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 the experience of selected individuals, which may vary above and below the stated amounts.

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