Clinical Reviewer, Radiation Therapy ( WEST COAST HOURS)

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: To ensure the appropriate utilization of services act as an advocate for our members and to ensure the highest quality and cost-effective care. Collaboration Opportunities: As a Radiation Technologist in the Utilization Management department, you will work closely with other nurses, managers, medical directors, and upper leadership as requested. What You Will Be Doing: Reviews Provider request for relevant and complete supporting documentation and requests for missing or additional documentation from providers per guidelines. Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN has the authority to authorize services or procedures. If a request does not meet established clinical guidelines for appropriateness and medical necessity, the request is sent to a physician reviewer. At no time can a URN recommend an adverse determination. Verifies accuracy of codes and services and applies them accurately with appropriate documentation. Ensures regulatory guidelines are met for timeliness and use of medical review criteria. Acts with honor and integrity, serving as a role model for the company while establishing and maintaining professional relationships with Providers and office staff. Complies with HIPAA requirements and all Evolent policies and procedures. Performs other duties as assigned including and not limited to develop report data elements.

Qualifications

Required and Preferred: American Registry of Radiologic Technologists (ARRT) certification is current and in good standing in your home state. (Required) Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel. (Required) Able to work in a fast-paced environment, and demonstrate excellent problem-solving, critical thinking, and organizational skills. (Required) Strong computer skills in Microsoft Office programs as well as EMR, SharePoint, and website navigation and email organization. - Required Required shift of 9:30AM - 6:00PM PST M-F, occasional weekends and holidays required with advance scheduling. - Required Applicant can reside in any location. MUST BE ABLE TO WORK PACIFIC COAST HOURS - Required 2 - 4 years UM experience - Preferred To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. 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. 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 [email protected] for further assistance. The expected base salary/wage range for this position is $38-39/hour.. 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.