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Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

Evolent partners with health plans and providers to achieve better outcomes for people with complex health conditions. Working across medical specialties and primary care, we seek to ensure that care plans align with clinical evidence, respect members’ goals and preferences, and connect seamlessly across providers and settings. We believe that every person deserves the same level of care and compassion we would want for our loved ones.

An independent and health plan-agnostic company, we currently partner with more than 70 plans and risk-bearing provider groups to better manage both the quality and cost of care. Through a comprehensive suite of resources—such as high-value clinical pathways, electronic decision support and value-based payment models—we create an ecosystem that helps providers deliver better, more affordable care to their patients. More than 40 million Americans have access to our clinical expertise through their health coverage.

The rising cost of health care is unsustainable, and we believe every patient deserves higher quality care at lower costs. Founded in 2011, Evolent is a fast paced, high growth organization with a longstanding mission of changing the health of the nation by changing the way health care is delivered. With a sharper focus on specialty care, our products and offerings are coming together to help people navigate care across a fragmented and complex health care system.

About the Role

The Chief Clinical Officer (CCO) is a key leader in the Clinical Services organization reporting directly to the Chief Medical Officer. The CCO will lead the Clinical Operations team and work with medical director leadership to ensure consistent and efficient adjudication of clinical decisions. The CCO will be responsible for leadership, professional development, and performance of the clinical operations team. Within the Clinical Services team, the CCO will also have dotted line oversight over field medical director (FMD) operational responsibilities, provide strategic input into medical policy and advise new program development. Additionally, the CCO will work closely with enterprise partners, including product, core operations, technology, P/L owners, and compliance, to build new value-based specialty products.

The CCO will facilitate the delivery of high-quality, coordinated, and efficient care across all business units with an intent to achieve the quintuple aim. Clinical operations leaders will report directly to the CCO and field medical directors will have a dotted line reporting structure. The CCO will be the single point of responsibility for all clinical operations inclusive of nurse, physician, and shared services performance. and core work can be divided into three domains: clinical integration and standardization, innovation in approaches to specialty care affordability, and advancement in patient impact and quality, including health equity.

Clinical Management Responsibilities

• Accountability for operational performance of physician, nursing, and shared services staff in the utilization management value chain

• Owns clinical rationale for utilization management decisions made by all clinical staff

• Ensures consistent clinical decision making by nurse and physician reviewers to maximize clinical outcomes and to ensure adherence to regulatory standards

• Makes final clinical decision on escalated reviews

• Maintains expertise in domains that are clinically relevant to Evolent including radiology, musculoskeletal disease, oncology and cardiology

Leadership Responsibilities

Strategic

• Participates in the development and implementation of new strategies to make the clinical review process more efficient through people, processes, and technology levers

• Contributes to the design of new value-based care programs for oncology, cardiology, and musculoskeletal disease

Leadership/management

• Leads performance management of clinical teams to meet productivity measures and regulatory requirements

• Leads efforts to generate innovative clinical ideas from all clinical staff with focus on identifying interventions that can be implemented in collaboration with providers during the utilization management process

• Leads career development for staff

Customer partnerships

• Represents Evolent on external customer meetings including Joint Operating Committee meetings and new market opportunities

• Builds key relationship with customer clinical teams, including the CMO, to align on clinical objectives

Desired Skill Set

• Understanding of regulatory framework for utilization management in Medicare, Medicaid, and Commercial contexts

• 5+ years leading utilization management program

• The ideal candidate will have a demonstrated record of accomplishment with, and commitment to, supporting the execution of population health, value-based care, clinical quality and clinical operation initiatives within a progressive and forward-thinking health care organization.

• Experience in health plan operations and/or managed care highly desirable.

• High level of financial acumen, with prior P&L responsibility preferred.

• Proficiency creating and leading presentations to key stakeholders inside and outside of the organization, including health plan executives, investors, physician groups and trade associations.

• Comfort and skill in leading and managing significant and fast-paced organizational change and clinical integration.

• A background in clinical informatics and/or technology

• Demonstrated ability to engage, inspire and galvanize teams around mission and impact generally, and in the midst of business transformation.

• Growth mindset willing to test new interventions alongside other teams.

• Authentic voice used to center patient and provider experience internally and externally.

• Ability to work as a utility player across growth, business development, financial and analytics teams, along with clinical workforce and operations.

• Ability to work within national coalitions to effectively advocate for payment reform, quality and health equity at CMS/CMMI, within professional organizations and guilds, and across health plan partners.

Qualifications for the Role

• MD/DO/MBBA Physician

• Active/Unrestricted Medical License in one or more states

• Board Certified (ABMS or Specialty Board)

• 10+ years managing clinical/physician teams

• 5+ clinical practice experience

• 5+ years of senior level experience leading clinical operations in a health plan environment

The position is remote with 20% travel expected.

Technical Requirements:

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 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. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $-. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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