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Evolent Health Medical Director, Behavioral Health in Topeka, Kansas

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 – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. 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.

What You’ll Be Doing:

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 power that brings us to work each day. We believe in embracing new ideas, testing 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. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. 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:

Evolent Health is looking for a Behavioral Health Medical Director to be a member of the Evolent clinical team. 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 our members.

**This is a full time position.

As Behavioral Health Medical Director your primary area of responsibility is to provide Medical Director support of Utilization Management activities for the designated health plan or Evolent partner's.

What You’ll Be Doing:

  • Serve as primary MD reviewer for the market (supported by Lead BH MD)

  • Support the BH UM line staff and be available for consultation and input on cases

  • Lead with clinical leaders weekly BH UM rounds

  • Responds to questions on cases from the health plan

  • When required, participates in case conferences with groups responsible for case management

  • When required, participates in meetings and conference calls with facilities and providers (attendance would be discussed with Lead BH MD)

  • Performs pre-admission review, utilization management, and concurrent and retrospective review process.

  • Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs,

  • Responsible for executing and maintaining Evolent Health’s benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs

  • Participate in the Appeals and Grievance process, as necessary, to assure timely and accurate responses to members

  • Supports design and implementation of health plan medical policies, and appropriate Care Management and UM goals and objectives

  • Provides clinical support and development for population health programs or functional areas within Medical Management.

  • Serves as a lead physician on the medical management team working closely with clinical and market leadership, in addition to providing direction for program development of the integrated behavioral health program

  • Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.

  • Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers

  • Participate in committees as assigned

  • Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.

  • Evaluates and ensures systems and processes to assist providers with adherence to evidence based protocols

  • Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.

The Experience You’ll Need (Required):

  • Board certification in Psychiatry

  • Graduate of an accredited medical school. M. D. Degree is required. Active physician license without any restrictions.

  • 3-5 years of clinical practice in a primary care setting and progressively responsible medical administrative experience preferred.

Finishing Touches (Preferred):

  • TX License 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 committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, 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 Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Evolent Health 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.

Compensation Range:

The typical range of employees within the compensation grade of this position is . Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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