Field Medical Director, MSK Surgery

Evolent

. Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases that do not initially meet applicable medical necessity guidelines .

Posted 9/18/2026full-timeRemote • United StatesLead💰 $140 - $150 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Clinical Review and Utilization Management, ensuring compliance with medical necessity guidelines and regulatory standards. Possesses strong communication and organizational skills to effectively collaborate with physicians and management staff.

Highest-signal resume keywords

MD/DO/MBBSActive Board Certification in Orthopedic SurgeryFive Years’ Experience in MedicineCurrent, Unrestricted Clinical LicenseComputer Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Soft Skills

Strong Communication SkillsOrganizational SkillsManagement Skills

Certifications & Qualifications

Active Board Certification in Orthopedic Surgery

Industry Keywords

Clinical ReviewUtilization ManagementMedical Necessity GuidelinesURACNCQAPeer-to-Peer CallsInter-Rater ReliabilityComplianceMedical Office Staff InteractionBackground Check

About the role

Key responsibilities & impact

Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases that do not initially meet applicable medical necessity guidelines
Review other imaging requests when specialty review is required by providers, clients, or state laws
Discuss determinations with requesting physicians or ordering providers through peer-to-peer calls within regulatory timeframes
Provide clinical rationale for standard and expedited appeals
Use medical/clinical review guidelines and parameters to ensure consistency, appropriate utilization, and compliance with SBU policies/procedures, URAC, and NCQA guidelines
Act as a resource to Initial Clinical Reviewers
Document communications with medical office staff and physician providers accurately and promptly
Assist the Senior Medical Director with utilization management research, interpretation, guidelines, and/or system support
Participate in ongoing training through the inter-rater reliability process
Routinely interact with leadership, management staff, physicians, and other staff when physician input is needed

Requirements

What you’ll need

MD/DO/MBBS
Minimum of five (5) years’ experience in the practice of Medicine, post residency
Active Clinical practice within the last 2 years is highly preferred
Current, unrestricted clinical license in medicine or required specialty
Obtaining and maintaining medical licenses in the state you reside, as well as any license required per business needs
Active Board Certification in Orthopedic Surgery
Strong clinical, management, communication, and organizational skills
Computer proficiency
Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid
No history of a major disciplinary or legal action by a state medical board
High-speed internet over 10 Mbps at home
Ability for call center employees to plug directly into the home internet router
Government-issued photo ID submission and identity verification during interviews
Comprehensive background check
In-person I-9 verification
May be subject to drug screening prior to employment

Benefits

Comp & perks

Work/life balance
Flexible work arrangements
Autonomy to get things done
Supportive and inclusive work environment
Comprehensive benefits, including health insurance benefits, for qualifying employees