Job DescriptionLead 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.

Skills:
Algorithms, Best Practices, Cancer, Clinical Practices/Protocols, Clinical Study Publications, Clinical Support, Continuous Improvement, Establish Priorities, Healthcare, Leadership, National Committee for Quality Assurance (NCQA), Oncology, Operational Audit, Patient Care, Performance Metrics, Quality Metrics, Team Player, Time Management, Utilization Management, Utilization Review Accreditation Commission (URAC)

About the Company:
Evolent