Cardiology - Interventional Physician
At a glance
Cardiologist role at Evolent. Virginia · full-time.
Pay not stated
physicianroles summary, based on the employer's listing.
What you'll do
- Assess cardiovascular requests such as catheterizations, coronary procedures and implantable devices when specialist review is needed
- Talk through care decisions with treating providers and explain the clinical basis for routine and expedited appeals
- Help initial reviewers navigate difficult cases, and partner with clinical leaders on review decisions
- Use clinical criteria to keep reviews consistent, record provider contacts promptly and accurately, and complete ongoing training
What you bring
- An MD, DO or MBBS degree, plus an active, unrestricted medical license
- Current Interventional Cardiology board certification, or one of the listed Cardiology certification and practice alternatives
- Maintain a license where you live and obtain other state licenses when business needs require them
- Strong clinical, management, communication and organizational abilities, along with computer proficiency
- No active exclusion or sanction from a state or federal health program, and no serious state medical board disciplinary or legal history
Who this fits
This is a non-clinical role for an interventional cardiologist, centered on case reviews and discussions with treating providers. The work is remote from any state, with flexible scheduling and part-time or full-time options. At least 5 years of Cardiology practice is preferred.
From the employer
Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)
Are you ready to make a meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the delivery of high-value, evidence-based case reviews. Enjoy improved work-life balance while contributing to better health outcomes in an environment that fosters collaboration, continuous learning, and impactful peer-to-peer discussions.
What We Offer:
A meaningful way to contribute to patient care beyond the clinical setting.
Opportunities for collaboration with a dynamic team of physicians, leaders, and clinical professionals.
A role that values innovation, continuous improvement, and clinical excellence.
This position is 100% Remote and can be completed from any state. Multiple opportunities for a flexible schedule and both part-time and full-time options available.
What You'll Do:
Provide expert reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (e.g., cardiac catheterizations, coronary interventions, endovascular procedures, implantable cardiac devices, etc) that do not initially meet medical necessity guidelines or require further evaluation by a subject matter expert.
Conduct peer-to-peer discussions with treating providers to ensure appropriate, high-value care aligned with clinical guidelines.
Collaborate with leadership, management, and clinical staff to address complex cases and support decision-making.
Act as a key resource for Initial Clinical Reviewers, offering guidance and expertise to ensure the application of best practices.
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
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 Interventional Cardiology or may be substituted for one of the following:
Active Board Certification in Cardiology and proof of prior board certification in Interventional Cardiology
Active Board Certification in Cardiology and proof of active practice as an Interventional Cardiologist for 5+ years
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