Senior Medical Director, Oncology Solutions- EviCore

The Senior Medical Director, Oncology Solutions, is a critical intraday leader of EviCore's Oncology management programs and services.

Responsibilities include:


* Serve as a coach, mentor, and/or clinical supervisor for adult and pediatric oncology Medical Directors


* Assist in implementing and managing aspects of both the oncology imaging and the medical oncology programs as necessary


* Serve as a Subject Matter Expert and first point of contact for Medical Directors who are seeking assistance with problematic case reviews, or escalated cases that deserve immediate review and attention


* Respond to urgent, expedited, or escalated cases and P2Ps within areas of expertise


* Assist in reviewing case determinations from clients responding to a provider or member complaint


* Assist in case audits to assess the accuracy of Medical Directors' decision making and adherence to the EviCore criteria and processes


* Assist in responding to notifications and requests to amend incorrect reviews when the physician reviewer who initially reviewed the case is not available


* Support sales and client management teams as clinical representative for designated program when requested by Executive Medical Director, Associate Chief Medical Officer, Chief Medical Officer, or General Manager


* Provide timely expert medical review of medical necessity requests for clinical services and renders a clinical opinion about the medical service under review, including post-decision reviews


* Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions


* Document all actions related to clinical review sessions and attests to review qualifications as required


* Maintain necessary credentials and immediately informs EviCore of any adverse actions relating to medical licenses and/or board certifications


* Support the review and maintain updates of EviCore clinical guidelines


* Support and communicates EviCore policies and procedures to the provider community.


* Assist with staff educational training and in-service programs and serves as a clinical resource for EviCore staff


* Participate in all required educational and quality improvement activities and maintain passing scores in all assessments


* Minimum Education, Licensure and Professional Certification requirement : • M.D.

or D.O.

degree from accredited institution.

• Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable) • Active board certification in medical or surgical specialty or subspecialty Other duties as assigned


* Minimum Experience required (number of years necessary to perform role) :


* Two (2) or more years of managed care experience


* Familiarity with automated processes and computer applications and sy...