À propos de ce poste Oncology Physician Clinical Reviewer chez Evolent Health
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:
Lead the Transformation in Oncology Care
At Evolent, we’re redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal role in advancing value-based care models that prioritize clinical excellence, patient-centered outcomes, and system-wide impact. This role offers the opportunity to collaborate with top-tier clinicians, influence care pathways, and drive innovation in one of the most critical areas of health care. If you're passionate about making a measurable difference in oncology, this is your platform to lead with purpose.
In this role, you will combine your clinical oncology expertise with a focus on value-based strategy and transformation. Unlike traditional medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation.
Core Responsibilities
Clinical Review & Peer Collaboration
Serve as the physician reviewer for oncology cases that do not initially meet medical necessity criteria, applying evidence-based guidelines to ensure high-quality and cost-effective care.
Conduct peer-to-peer discussions with requesting oncologists—not only to explain determinations but to partner in driving practice patterns aligned with value and quality outcomes.
Support clinical reviewers as a subject matter expert and resource.
Practice & Physician Engagement
Actively participate in engagement sessions with oncology practices, sharing best clinical practices and supporting broader adoption of evidence-based pathways.
Foster trusted peer relationships with oncologists to encourage sustainable behavior change that improves patient outcomes.
Support practice-level transformation initiatives that reduce unwarranted variation and enhance quality.
Internal Strategy & Value Initiatives
Collaborate with Evolent’s clinical leadership on the design, build, and execution of new value initiatives in oncology.
Provide input on innovation opportunities, clinical algorithms, and models of care that support transformation in specialty care.
Partner with operational and analytic teams to assess the impact of interventions and identify opportunities for continuous improvement.
Participate in audit processes to validate accuracy of advance payment model payouts, ensuring alignment with clinical documentation, performance metrics, and contractual expectations.
Compliance & Quality
Ensure all reviews and engagements align with URAC, NCQA, and internal quality standards.
Document peer interactions and clinical decisions in a timely and accurate manner.
Participate in training and inter-rater reliability processes.
Qualifications
MD/DO/MBBS with board certification in Medical Oncology or Pediatric Oncology.
Minimum five (5) years’ post-residency experience, with active clinical practice preferred within the past 2 years.
Current, unrestricted medical license (multiple state licenses preferred or willingness to obtain).
Demonstrated leadership in practice transformation, value-based care, or clinical quality improvement.
Strong communication, collaboration, and organizational skills, with proven ability to influence physician behavior.
Energetic, curious, and passionate about shaping the future of oncology care delivery.
Not under sanction or exclusion from Medicare/Medicaid programs.
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.
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 [email protected] for further assistance.
The expected base salary/wage range for this position is $$130-$ 145/hr + potential sign on bonus. 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.
