[Hiring] Clinical Reviewer, Radiation Therapy @Evolent

Role Description 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

• Act as an advocate for our members to ensure appropriate utilization of services and the highest quality and cost-effective care.
• Work closely with other nurses, managers, medical directors, and upper leadership as requested.
• Review provider requests for relevant and complete supporting documentation and request missing or additional documentation from providers per guidelines.
• Utilize clinical guidelines approved by the Utilization Management Committee (UMC) to authorize services or procedures.
• Send requests that do not meet established clinical guidelines for appropriateness and medical necessity to a physician reviewer.
• Verify accuracy of codes and services and apply them accurately with appropriate documentation.
• Ensure regulatory guidelines are met for timeliness and use of medical review criteria.
• Act with honor and integrity, serving as a role model for the company while establishing and maintaining professional relationships with providers and office staff.
• Comply with HIPAA requirements and all Evolent policies and procedures.
• Perform other duties as assigned, including developing report data elements.

Qualifications

• 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, demonstrating 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)

Requirements

• To ensure a secure hiring process, we have implemented several identity verification steps, including submission of a government issued photo ID.
• 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

• High speed internet over 10 Mbps is required.
• Call center employees must have the ability to plug in directly to the home internet router.

Benefits

• The expected base salary/wage range for this position is $38-39/hour.
• 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.