Clinical Operations & Physicians
Market Medical Director
Louisville , KY, United States

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Who You’ll Be Working With:

As a collaborative member of a team of nurses, social workers, physicians, pharmacists, health economists, and program coordinators, you will have the opportunity to make a profound impact on the lives of people living with multiple chronic illnesses. 

What You’ll Be Doing:

Population health – collaborative care management leadership

  • Provides clinical leadership and development for a population health programs or functional area within Medical Management, e.g, patient centered medical home, health and wellness, population management, high risk care management, reporting capability, etc.
  • Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
  • Helps recruit, develop and motivate population health-care management staff
  • Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers
  • Stratification, continuous evaluation and restratification of population for appropriate resource allocation


Physician and provider relationship management

  • Responsible leading change with physicians and other providers, especially PCMH practices, to improve the quality and efficiency of care in the network and integrate these providers into our clinical initiatives.
  • Visits network facilities on a regular basis, identifies key issues facing leaders and works collaboratively with leadership to accomplish mutually agreed upon goals.
  • Creates and maintain a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
  • Nurtures a culture where delivering the highest quality yields lowest cost
  • Participates in the development of physician incentives and gain sharing arrangements.
  • Provides critical thinking for analyzes, evaluation and modification ofdata reports (e.g., medical, pharmacy, quality) and assist Evolent stakeholders with the translation of information to knowledge and action to contracted physicians and providers.
  • Develop, maintain and grow relationships with key clinical leaders with the assigned market.

Quality of care and service delivery

  • Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.
  • Maintains up-to-date knowledge of new information and technologies in medicine and their application to Evolent’s clients
  • Evaluates and ensures systems and processes to assist providers with adherence to evidence based protocols
  • Chairs or staffs peer review committees and
  • Participate in the Appeals and Grievance process, as necessary, to assure timely, accurate responses to members
  • Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.

The Experience You’ll Need (Required):

  • Graduate of an accredited medical school. M. D. Degree is required. MBA, or a Master's Degree is preferred in healthcare, or other related fields of study.
  • 3-5 years of clinical practice in a primary care setting and progressively responsible medical administrative experience.

Finishing Touches (Preferred):

  • Proven ability in 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.

 

Evolent Health is an Equal Opportunity/Affirmative Action Employer