14 Healthcare Roles jobs in Center Ossipee

**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:**
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
+ 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 Will Be Doing:**
+ Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Provides clinical rationale for standard and expedited appeals.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ Participates in on-going training per inter-rater reliability process.
+ May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
+ On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.
**Qualifications - Required and Preferred:**
+ MD/DO/MBBS Degree
+ Current, unrestricted clinical license in medicine or required specialty
+ Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs
+ Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease
+ Strong clinical, management, communication, and organizational skills
+ Energetic and curious with a passion for quality and value in health care
+ Computer Proficiency
+ Minimum of five (5) years' experience in the practice of Cardiology 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. These at-home technical requirements are subject to change with any scheduled re-opening 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.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $120-$135/hr. This position is also eligible for a bonus component that would be dependent on pre-defined 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 experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**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:**
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
+ 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 Will Be Doing:**
+ Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Provides clinical rationale for standard and expedited appeals.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ Participates in on-going training per inter-rater reliability process.
+ May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
+ On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.
**Qualifications - Required and Preferred:**
+ MD/DO/MBBS Degree
+ Current, unrestricted clinical license in medicine or required specialty
+ Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs
+ Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease
+ Strong clinical, management, communication, and organizational skills
+ Energetic and curious with a passion for quality and value in health care
+ Computer Proficiency
+ Minimum of five (5) years' experience in the practice of Cardiology 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. These at-home technical requirements are subject to change with any scheduled re-opening 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.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $120-$135/hr. This position is also eligible for a bonus component that would be dependent on pre-defined 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 experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**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:**
As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
· Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required.
**What You Will Be Doing:**
· Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
· Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
· Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
· Aids and acts as a resource to Initial Clinical Reviewers.
· Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
· May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
· Participates in on-going training per inter-rater reliability process.
**Qualifications:**
· MD/DO/MBBS
· Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is 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 Adult Medical Oncology
· Strong clinical, management, communication, and organizational skills
· Energetic and curious with a passion for quality and value in health car
· Computer Proficiency
· 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 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. These at-home technical requirements are subject to change with any scheduled re-opening 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.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $110-$125. This position is also eligible for a bonus component that would be dependent on pre-defined 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 experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**ROLE SUMMARY**
The Field Medical Outcomes is a field medical colleague responsible for informing customer decision-making and improving population health through real-world data analytics, pharmacoeconomic analyses, outcomes evaluations and medical presentations. The role is responsible for educating customers on the clinical and economic impact of Pfizer medicines and products. The colleague may also be responsible for providing disease area/therapeutic area/product-based expertise for designated TA areas with a a primary focus on integrated health care organizations, including but not limited to Integrated Delivery Systems, Payer customers and Specialty Pharmacy Providers (SPPs).
The responsibilities of the role are to contribute to Pfizer's ability to (a) Plan and execute the independent Medical strategy and engagement for appropriate assigned customers within a territory, compliantly coordinating with other Pfizer colleagues as needed to achieve Medical objectives (b) Understand the priorities of Pfizer Medical Affairs in order to contribute to Medical educational content strategy development and execute aligned Field Medical tactics (c) Maintain effective and appropriate communication and collaboration among headquarters Medical colleagues, Medical Information, and other Pfizer Field Medical colleagues (d) Demonstrate expertise in scientific communication across multiple channels, including, but not limited to, live and virtual presentations in small or large settings, written communication, and telephone or virtual conversations (e) Compliantly integrate understanding of clinical, Health Information Technology (HIT), market, and account considerations to develop and execute mutually beneficial customer-specific projects, collaborations, strategic medical partnerships, and non-interventional studies with the goal of advancing quality of care and improving patient outcomes (f) Optimize patient care improvements in centricity of Medical communications and deliverables, incorporating Health Literacy and cultural awareness principles to ensure that patients remain the ultimate focus.
The role may interact with accounts in the region including Healthcare Decision Makers (HCDM) affiliated with organized customers. The colleague will respond to medical questions regarding Pfizer products for the designated therapeutic area and other Pfizer medicines as appropriate. The individual may be involved in presentations to payers, managed care organizations, formulary decision makers and regional medical advisory boards in accordance with the designated therapeutic area medical strategy. The Medical Outcomes colleague will also facilitate communication between regional and national HCOs and headquarters Medical Affairs colleagues and provide customer insights that contribute to the development of brand medical strategies as appropriate. The role may facilitate Pfizer sponsored research projects/studies which could include collaborative projects, quality improvement research and non-interventional studies.
The colleague will maintain required level of knowledge of relevant TA/disease states and Pfizer medicines, providing therapeutic area/product information to both internal and external stakeholders as needed, and serve as a conduit and resource for Medical Information and customer insights, providing requested information to medical stakeholders as allowed by Pfizer guidance and sharing customer viewpoints with Pfizer as appropriate
**ROLE RESPONSIBILITIES**
+ Ensure compliance with all internal/external SOPs/Rules/Regulations.
+ Provide objective and scientifically sound medical information regarding Pfizer's medicines and the disease states they treat through use of pharmacoeconomic models, outcomes tools, educational programs, Health Outcomes Projects and Evaluations (HOPEs), non-interventional studies, and collaborations
+ Appropriately prioritize the needs of the customer and of Pfizer to develop and implement objective and scientifically sound Real-World Evidence-based outcomes tools (such as HOPEs and educational programs) which identify the greatest opportunities for improving patient care, closing quality gaps, and addressing population health management
+ Serve as the Field Medical Outcomes lead for assigned customers, developing and executing a medical account plan while representing Medical Affairs, sharing insights from the customer, and identifying opportunities for collaboration to improve patient care
+ Understand the principles of study design, methodology, data analysis, and interpretation and communicate these concepts with customers
+ Appropriately engage with key stakeholders within the market, such as Quality Improvement Organizations, Advocacy Groups, Coalitions, and other medical/healthcare associations, to understand their population health priorities and identify opportunities that align with the strategic medical objectives of Pfizer
+ Provide Medical support and guidance for HIT initiatives including initial assessment, triaging opportunities for review, assessing organizational capabilities and feasibility, and providing clinical relevance to proposed HIT methodologies
+ Analyze workflows in the context of clinical healthcare information systems to facilitate care processes to reduce care gaps, improve care efficiencies, and maximize quality and population health
+ Facilitate development of clinical content that embodies the clinical perspective while effectively using information technology to develop strategy and build innovative tools and resources
+ Provide expertise on e-data collection and planning for Field Medical colleagues
+ Work cross-functionally within Pfizer guidance to identify, design, and deploy HIT solutions aligned with Pfizer Medical goals for Field Medical use
+ Support development of HIT/clinical informatics specific resources for new product and new indication launches
+ Maintain, continually develop, and utilize Clinical Informatics capabilities to enable effective collaborations with external customers
+ Serve as members of internal teams to further the impact of Field Medical Outcomes by creating tools, resources, and educational materials for use both internally and externally
+ Represent Pfizer Medical Affairs leadership with clinical/professional associations and/or societies, consistently demonstrating medical professionalism in all interactions
+ Enhance customer recognition of Pfizer Medical through collaborative projects, publications and healthcare awards
+ Providing approved medical content on Pfizer's products in the designated therapeutic area, with a primary focus on organized customers, including but not limited to National Payers, Regional Payers, and Specialty Pharmacy Providers (SPPs).
+ Demonstrate Pfizer Scientific Leadership by keeping abreast of medical and scientific developments in the designated therapeutic area by continuously reviewing literature in the field, evolving competitive landscape, networking with experts and attending assigned conferences
+ Respond to unsolicited requests from customers regarding scientific interpretation of clinical information and pharmacoeconomic impact of product selection to further advance formulary decision-making or patient outcomes through appropriate pharmaceutical care
+ Compliantly collaborate with internal Pfizer colleagues (including Key Account Managers, Account Directors, PHI, Field Medical, Headquarters Medical, CI, AME, and HEOR) to understand the outcomes of interest and data analysis needs of assigned customers
+ Maintain significant market and customer knowledge in an increasingly complex and dynamic marketplace
+ Manage a significant volume of projects developed in a field-based environment, while exhibiting the ability to prioritize, successfully implement, and demonstrate excellent judgment skills and work in a continuous improvement environment
+ Maintain an up-to-date status for internal training requirements
+ Conduct all activities in accordance with all relevant policies, procedures and compliance guidance
+ Educating HCOs based on patient care gaps and aligned to medical strategy with the goal of enhancing understanding of disease state and guideline-based care
+ Achieve leadership-defined expectations regarding the number of medical stakeholders engaged
+ Understand the priorities of PFE Medical Affairs in order to contribute to medical content strategy development and aligned field medical tactics
+ Provides strong territory/customer leadership
+ Serve on Medical, TA or cross-functional committees as appropriate
+ Mentorship and Onboarding partner
+ Maintain professional licensure and continually learn and grow in profession
**BASIC QUALIFICATIONS**
+ Candidate demonstrates a breadth of diverse leadership experiences and capabilities including: the ability to influence and collaborate with peers, develop and coach others, oversee and guide the work of other colleagues to achieve meaningful outcomes and create business impact
+ Bachelor's degree in health science required
+ PharmD, PhD, or equivalent terminal doctoral degree preferred
+ Relevant experience required: 8+ years with bachelor's degree; 7+ years with master's degree; 5+ years with terminal doctorate degree (PharmD, PhD)
+ Experience should be in any of the following:
+ Clinical, formulary, and/or other management experience
+ Managed Care, pharmaceutical industry, and/or Quality Improvement
+ Data Analytics and/or HEOR activities, with demonstrated strong methodological skills (study design, data analysis, and interpretation) in health services research
+ Significant experience in interacting with payers and other organized customers is required.
+ Excellent oral and written communication skills required.
+ Excellent and demonstrated interpersonal skills: ability to understand and respond to multiple external and internal customers' demands, manage and handle conflict constructively required.
+ Breadth of diverse leadership experiences and capabilities including the ability to influence and collaborate with peers and create business impact
+ Strong analytic skills including creativity and effectiveness in proactively identifying and addressing challenges
+ Strong comprehension and communication skills, including ability to communicate large amounts of scientific information in a manner that is clear and concise
+ Well-organized with the ability to be flexible, prioritize multiple demands, and employ strong situational leadership skills
+ Ability to travel, including overnight travel for internal and external meetings (customer, industry, and professional society meetings)
+ Ability to operate a Pfizer company car with a valid US Driver's License and regularly fly on airplanes; must be within a 2-hour drive of a major airport; flexibility to potentially travel 40 - 50% of time
**PREFERRED QUALIFICATIONS**
+ Previous experience in field-based medical/outcomes role
+ Experience analyzing health care data (claims, electronic health records, other health care data)
+ Expertise in Clinical Informatics or Health Information Technology (HIT), including working with claims data sets or Electronic Health Record (EHR) systems
+ Residency or Fellowship experience
+ Microsoft Access, statistics software, and/or data programming experience
+ Experience in the clinical, functional, and technical application of health information technology used in the U.S.
+ Experience with optimization/customization of EHR platforms, including developing EHR clinical solutions
+ Leadership in innovative project start-up and management
+ Understanding of the complex business environment within the US healthcare system as well as emerging healthcare trends
**NON-STANDARD WORK SCHEDULE, TRAVEL OR ENVIRONMENT REQUIREMENTS**
+ Valid US driver's license and driving record in compliance with company standards. Any DUI/DWI or other impaired driving citation within the past 7 years will disqualify you from being hired
+ Flexibility to travel 40-50% of time.
+ Reasonable proximity to airline 'hub' city
+ Ability to work on weekends occasionally (e.g. attend advisory boards and congress meetings)
+ Ability to operate a Pfizer company car and regularly fly on airplanes (i.e. attend medical stakeholder meetings; attend HQ meetings, regional and national scientific meetings, etc.) required
**Other Job Details**
+ Last Date to Apply for Job: October 14, 2025
+ Eligible for Relocation Package: No
#LI-PFE
The annual base salary for this position ranges from $169,700.00 to $282,900.00. In addition, this position is eligible for participation in Pfizer's Global Performance Plan with a bonus target of 20.0% of the base salary and eligibility to participate in our share based long term incentive program. We offer comprehensive and generous benefits and programs to help our colleagues lead healthy lives and to support each of life's moments. Benefits offered include a 401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution, paid vacation, holiday and personal days, paid caregiver/parental and medical leave, and health benefits to include medical, prescription drug, dental and vision coverage. Learn more at Pfizer Candidate Site - U.S. Benefits | (uscandidates.mypfizerbenefits.com). Pfizer compensation structures and benefit packages are aligned based on the location of hire. The United States salary range provided does not apply to Tampa, FL or any location outside of the United States.
Relocation assistance may be available based on business needs and/or eligibility.
**Sunshine Act**
Pfizer reports payments and other transfers of value to health care providers as required by federal and state transparency laws and implementing regulations. These laws and regulations require Pfizer to provide government agencies with information such as a health care provider's name, address and the type of payments or other value received, generally for public disclosure. Subject to further legal review and statutory or regulatory clarification, which Pfizer intends to pursue, reimbursement of recruiting expenses for licensed physicians may constitute a reportable transfer of value under the federal transparency law commonly known as the Sunshine Act. Therefore, if you are a licensed physician who incurs recruiting expenses as a result of interviewing with Pfizer that we pay or reimburse, your name, address and the amount of payments made currently will be reported to the government. If you have questions regarding this matter, please do not hesitate to contact your Talent Acquisition representative.
**EEO & Employment Eligibility**
Pfizer is committed to equal opportunity in the terms and conditions of employment for all employees and job applicants without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability or veteran status. Pfizer also complies with all applicable national, state and local laws governing nondiscrimination in employment as well as work authorization and employment eligibility verification requirements of the Immigration and Nationality Act and IRCA. Pfizer is an E-Verify employer. This position requires permanent work authorization in the United States.
Pfizer endeavors to make accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process and/or interviewing, please email This is to be used solely for accommodation requests with respect to the accessibility of our website, online application process and/or interviewing. Requests for any other reason will not be returned.
Medical

**ROLE SUMMARY**
The Field Medical Outcomes is a field medical colleague responsible for informing customer decision-making and improving population health through real-world data analytics, pharmacoeconomic analyses, outcomes evaluations and medical presentations. The role is responsible for educating customers on the clinical and economic impact of Pfizer medicines and products. The colleague may also be responsible for providing disease area/therapeutic area/product-based expertise for designated TA areas with a a primary focus on integrated health care organizations, including but not limited to Integrated Delivery Systems, Payer customers and Specialty Pharmacy Providers (SPPs).
The responsibilities of the role are to contribute to Pfizer's ability to (a) Plan and execute the independent Medical strategy and engagement for appropriate assigned customers within a territory, compliantly coordinating with other Pfizer colleagues as needed to achieve Medical objectives (b) Understand the priorities of Pfizer Medical Affairs in order to contribute to Medical educational content strategy development and execute aligned Field Medical tactics (c) Maintain effective and appropriate communication and collaboration among headquarters Medical colleagues, Medical Information, and other Pfizer Field Medical colleagues (d) Demonstrate expertise in scientific communication across multiple channels, including, but not limited to, live and virtual presentations in small or large settings, written communication, and telephone or virtual conversations (e) Compliantly integrate understanding of clinical, Health Information Technology (HIT), market, and account considerations to develop and execute mutually beneficial customer-specific projects, collaborations, strategic medical partnerships, and non-interventional studies with the goal of advancing quality of care and improving patient outcomes (f) Optimize patient care improvements in centricity of Medical communications and deliverables, incorporating Health Literacy and cultural awareness principles to ensure that patients remain the ultimate focus.
The role may interact with accounts in the region including Healthcare Decision Makers (HCDM) affiliated with organized customers. The colleague will respond to medical questions regarding Pfizer products for the designated therapeutic area and other Pfizer medicines as appropriate. The individual may be involved in presentations to payers, managed care organizations, formulary decision makers and regional medical advisory boards in accordance with the designated therapeutic area medical strategy. The Medical Outcomes colleague will also facilitate communication between regional and national HCOs and headquarters Medical Affairs colleagues and provide customer insights that contribute to the development of brand medical strategies as appropriate. The role may facilitate Pfizer sponsored research projects/studies which could include collaborative projects, quality improvement research and non-interventional studies.
The colleague will maintain required level of knowledge of relevant TA/disease states and Pfizer medicines, providing therapeutic area/product information to both internal and external stakeholders as needed, and serve as a conduit and resource for Medical Information and customer insights, providing requested information to medical stakeholders as allowed by Pfizer guidance and sharing customer viewpoints with Pfizer as appropriate
**ROLE RESPONSIBILITIES**
+ Ensure compliance with all internal/external SOPs/Rules/Regulations.
+ Provide objective and scientifically sound medical information regarding Pfizer's medicines and the disease states they treat through use of pharmacoeconomic models, outcomes tools, educational programs, Health Outcomes Projects and Evaluations (HOPEs), non-interventional studies, and collaborations
+ Appropriately prioritize the needs of the customer and of Pfizer to develop and implement objective and scientifically sound Real-World Evidence-based outcomes tools (such as HOPEs and educational programs) which identify the greatest opportunities for improving patient care, closing quality gaps, and addressing population health management
+ Serve as the Field Medical Outcomes lead for assigned customers, developing and executing a medical account plan while representing Medical Affairs, sharing insights from the customer, and identifying opportunities for collaboration to improve patient care
+ Understand the principles of study design, methodology, data analysis, and interpretation and communicate these concepts with customers
+ Appropriately engage with key stakeholders within the market, such as Quality Improvement Organizations, Advocacy Groups, Coalitions, and other medical/healthcare associations, to understand their population health priorities and identify opportunities that align with the strategic medical objectives of Pfizer
+ Provide Medical support and guidance for HIT initiatives including initial assessment, triaging opportunities for review, assessing organizational capabilities and feasibility, and providing clinical relevance to proposed HIT methodologies
+ Analyze workflows in the context of clinical healthcare information systems to facilitate care processes to reduce care gaps, improve care efficiencies, and maximize quality and population health
+ Facilitate development of clinical content that embodies the clinical perspective while effectively using information technology to develop strategy and build innovative tools and resources
+ Provide expertise on e-data collection and planning for Field Medical colleagues
+ Work cross-functionally within Pfizer guidance to identify, design, and deploy HIT solutions aligned with Pfizer Medical goals for Field Medical use
+ Support development of HIT/clinical informatics specific resources for new product and new indication launches
+ Maintain, continually develop, and utilize Clinical Informatics capabilities to enable effective collaborations with external customers
+ Serve as members of internal teams to further the impact of Field Medical Outcomes by creating tools, resources, and educational materials for use both internally and externally
+ Represent Pfizer Medical Affairs leadership with clinical/professional associations and/or societies, consistently demonstrating medical professionalism in all interactions
+ Enhance customer recognition of Pfizer Medical through collaborative projects, publications and healthcare awards
+ Providing approved medical content on Pfizer's products in the designated therapeutic area, with a primary focus on organized customers, including but not limited to National Payers, Regional Payers, and Specialty Pharmacy Providers (SPPs).
+ Demonstrate Pfizer Scientific Leadership by keeping abreast of medical and scientific developments in the designated therapeutic area by continuously reviewing literature in the field, evolving competitive landscape, networking with experts and attending assigned conferences
+ Respond to unsolicited requests from customers regarding scientific interpretation of clinical information and pharmacoeconomic impact of product selection to further advance formulary decision-making or patient outcomes through appropriate pharmaceutical care
+ Compliantly collaborate with internal Pfizer colleagues (including Key Account Managers, Account Directors, PHI, Field Medical, Headquarters Medical, CI, AME, and HEOR) to understand the outcomes of interest and data analysis needs of assigned customers
+ Maintain significant market and customer knowledge in an increasingly complex and dynamic marketplace
+ Manage a significant volume of projects developed in a field-based environment, while exhibiting the ability to prioritize, successfully implement, and demonstrate excellent judgment skills and work in a continuous improvement environment
+ Maintain an up-to-date status for internal training requirements
+ Conduct all activities in accordance with all relevant policies, procedures and compliance guidance
+ Educating HCOs based on patient care gaps and aligned to medical strategy with the goal of enhancing understanding of disease state and guideline-based care
+ Achieve leadership-defined expectations regarding the number of medical stakeholders engaged
+ Understand the priorities of PFE Medical Affairs in order to contribute to medical content strategy development and aligned field medical tactics
+ Provides strong territory/customer leadership
+ Serve on Medical, TA or cross-functional committees as appropriate
+ Mentorship and Onboarding partner
+ Maintain professional licensure and continually learn and grow in profession
**BASIC QUALIFICATIONS**
+ Candidate demonstrates a breadth of diverse leadership experiences and capabilities including: the ability to influence and collaborate with peers, develop and coach others, oversee and guide the work of other colleagues to achieve meaningful outcomes and create business impact
+ Bachelor's degree in health science required
+ MD or DO with 4+ years relevant experience required
+ Experience should be in any of the following:
+ Clinical, formulary, and/or other management experience
+ Managed Care, pharmaceutical industry, and/or Quality Improvement
+ Data Analytics and/or HEOR activities, with demonstrated strong methodological skills (study design, data analysis, and interpretation) in health services research
+ Significant experience in interacting with payers and other organized customers is required.
+ Excellent oral and written communication skills required.
+ Excellent and demonstrated interpersonal skills: ability to understand and respond to multiple external and internal customers' demands, manage and handle conflict constructively required.
+ Breadth of diverse leadership experiences and capabilities including the ability to influence and collaborate with peers and create business impact
+ Strong analytic skills including creativity and effectiveness in proactively identifying and addressing challenges
+ Strong comprehension and communication skills, including ability to communicate large amounts of scientific information in a manner that is clear and concise
+ Well-organized with the ability to be flexible, prioritize multiple demands, and employ strong situational leadership skills
+ Ability to travel, including overnight travel for internal and external meetings (customer, industry, and professional society meetings)
+ Ability to operate a Pfizer company car with a valid US Driver's License and regularly fly on airplanes; must be within a 2-hour drive of a major airport; flexibility to potentially travel 40 - 50% of time
**PREFERRED QUALIFICATIONS**
+ Previous experience in field-based medical/outcomes role
+ Experience analyzing health care data (claims, electronic health records, other health care data)
+ Expertise in Clinical Informatics or Health Information Technology (HIT), including working with claims data sets or Electronic Health Record (EHR) systems
+ Residency or Fellowship experience
+ Microsoft Access, statistics software, and/or data programming experience
+ Experience in the clinical, functional, and technical application of health information technology used in the U.S.
+ Experience with optimization/customization of EHR platforms, including developing EHR clinical solutions
+ Leadership in innovative project start-up and management
+ Understanding of the complex business environment within the US healthcare system as well as emerging healthcare trends
**NON-STANDARD WORK SCHEDULE, TRAVEL OR ENVIRONMENT REQUIREMENTS**
+ Valid US driver's license and driving record in compliance with company standards. Any DUI/DWI or other impaired driving citation within the past 7 years will disqualify you from being hired
+ Flexibility to travel 40-50% of time.
+ Reasonable proximity to airline 'hub' city
+ Ability to work on weekends occasionally (e.g. attend advisory boards and congress meetings)
+ Ability to operate a Pfizer company car and regularly fly on airplanes (i.e. attend medical stakeholder meetings; attend HQ meetings, regional and national scientific meetings, etc.) required
**Other Job Details**
+ Last Date to Apply for Job: October 14, 2025
+ Eligible for Relocation Package: No
#LI-PFE
The annual base salary for this position ranges from $219,800.00 to $366,400.00. In addition, this position is eligible for participation in Pfizer's Global Performance Plan with a bonus target of 25.0% of the base salary and eligibility to participate in our share based long term incentive program. We offer comprehensive and generous benefits and programs to help our colleagues lead healthy lives and to support each of life's moments. Benefits offered include a 401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution, paid vacation, holiday and personal days, paid caregiver/parental and medical leave, and health benefits to include medical, prescription drug, dental and vision coverage. Learn more at Pfizer Candidate Site - U.S. Benefits | (uscandidates.mypfizerbenefits.com). Pfizer compensation structures and benefit packages are aligned based on the location of hire. The United States salary range provided does not apply to Tampa, FL or any location outside of the United States.
Relocation assistance may be available based on business needs and/or eligibility.
**Sunshine Act**
Pfizer reports payments and other transfers of value to health care providers as required by federal and state transparency laws and implementing regulations. These laws and regulations require Pfizer to provide government agencies with information such as a health care provider's name, address and the type of payments or other value received, generally for public disclosure. Subject to further legal review and statutory or regulatory clarification, which Pfizer intends to pursue, reimbursement of recruiting expenses for licensed physicians may constitute a reportable transfer of value under the federal transparency law commonly known as the Sunshine Act. Therefore, if you are a licensed physician who incurs recruiting expenses as a result of interviewing with Pfizer that we pay or reimburse, your name, address and the amount of payments made currently will be reported to the government. If you have questions regarding this matter, please do not hesitate to contact your Talent Acquisition representative.
**EEO & Employment Eligibility**
Pfizer is committed to equal opportunity in the terms and conditions of employment for all employees and job applicants without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability or veteran status. Pfizer also complies with all applicable national, state and local laws governing nondiscrimination in employment as well as work authorization and employment eligibility verification requirements of the Immigration and Nationality Act and IRCA. Pfizer is an E-Verify employer. This position requires permanent work authorization in the United States.
Pfizer endeavors to make accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process and/or interviewing, please email This is to be used solely for accommodation requests with respect to the accessibility of our website, online application process and/or interviewing. Requests for any other reason will not be returned.
Medical

**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:**
As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
+ Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. Aids and acts as a resource to Initial Clinical Reviewers.
**What You Will Be Doing:**
+ Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Provides clinical rationale for standard and expedited appeals.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ Participates in on-going training per inter-rater reliability process.
+ On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in research activities/questions.
**Qualifications - Required and Preferred:**
+ MD/DO/MBBS- **Required**
+ Minimum of five (5) years' experience in the practice of Pain Medicine, post-residency- **Preferred**
+ Current, unrestricted clinical license in medicine or required specialty- **Required**
+ Obtaining and maintaining medical licenses in the state you reside and any required per business needs- **Required**
+ Active Board Certification in Pain Management or Active Board Certification in another specialty and clinical experience in Interventional Pain Management- **Required**
+ Strong clinical, management, communication, and organizational skills- **Required**
+ Energetic and curious with a passion for quality and value in health care- **Required**
+ Computer Proficiency- **Required**
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. These at-home technical requirements are subject to change with any scheduled re-opening 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.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $100-$110/hr. This position is also eligible for a bonus component that would be dependent on pre-defined 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 experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**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:**
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
+ Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required.
**What You Will Be Doing:**
+ Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Aids and acts as a resource to Initial Clinical Reviewers.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
+ Participates in on-going training per inter-rater reliability process.
**Qualifications:**
+ MD/DO/MBBS
+ Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is 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 by an accredited organization
+ Strong clinical, management, communication, and organizational skills
+ Energetic and curious with a passion for quality and value in health care
+ Computer Proficiency
+ 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. These at-home technical requirements are subject to change with any scheduled re-opening 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.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $94-99/hr. This position is also eligible for a bonus component that would be dependent on pre-defined 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 experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**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:**
As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
**Collaboration Opportunities:**
+ Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. Aids and acts as a resource to Initial Clinical Reviewers.
**What You Will Be Doing:**
+ Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Provides clinical rationale for standard and expedited appeals.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ Participates in on-going training per inter-rater reliability process.
+ On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in research activities/questions.
**Qualifications - Required and Preferred:**
+ MD/DO/MBBS- **Required**
+ Minimum of five (5) years' experience in the practice of Pain Medicine, post-residency- **Preferred**
+ Current, unrestricted clinical license in medicine or required specialty- **Required**
+ Obtaining and maintaining medical licenses in the state you reside and any required per business needs- **Required**
+ Active Board Certification in Pain Management or Active Board Certification in another specialty and clinical experience in Interventional Pain Management- **Required**
+ Strong clinical, management, communication, and organizational skills- **Required**
+ Energetic and curious with a passion for quality and value in health care- **Required**
+ Computer Proficiency- **Required**
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. These at-home technical requirements are subject to change with any scheduled re-opening 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.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $105-110/hr. This position is also eligible for a bonus component that would be dependent on pre-defined 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 experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**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:**
What You Will Be Doing:
+ Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
+ Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
+ Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
+ Aids and acts as a resource to Initial Clinical Reviewers.
+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
+ May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
+ Participates in on-going training per inter-rater reliability process.
Qualifications-
+ MD/DO/MBBS
+ Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is 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 Medical Oncology
+ Strong clinical, management, communication, and organizational skills
+ Energetic and curious with a passion for quality and value in health care
+ Computer Proficiency
+ 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. These at-home technical requirements are subject to change with any scheduled re-opening 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.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
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 pre-defined 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 experience of selected individuals, which may vary above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!