Oncology Physician Clinical Reviewer

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 topartner 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 inengagement sessions with oncology practices, sharing best clinical practices and supporting broader adoption of evidence-based pathways.

  • Foster trusted peer relationships with oncologists to encouragesustainable behavior changethat 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 thedesign, 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 inMedical 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).

• Demonstratedleadership 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 aboutshaping the future of oncology care delivery.

• Not under sanction or exclusion from Medicare/Medicaid programs.