[Hiring] Clinical Reviewer, Nurse @Evolent
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Role Description
As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients’ lives, in a non-clinical environment. You can enjoy better work-life balance on a team that values collaboration and continuous learning while providing better health outcomes.
• Functions in a clinical review capacity to evaluate all cases that do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff.
• Reviews charts and analyzes clinical record documentation to approve services that meet clinical review criteria.
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff.
• Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes.
• Documents all communication with medical office staff and/or treating provider.
• Practices and maintains the principles of utilization management by adhering to policies and procedures.
• Participates in ongoing training programs to ensure quality performance in compliance with applicable standards and regulations, as well as being audited to ensure guidelines are applied appropriately.
Qualifications
• A current RN clinical license, active and in good standing, in your home state - Required
• Associate or Bachelors in Nursing (Must be a Registered Nurse) - Required
• You must be able to work a minimum of 30 hours/week - Required
• Strong interpersonal and communication skills - Required
• Proficient computer skills; must be able to talk and type simultaneously - Required
• 5+ years clinical experience - Preferred
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.
Benefits
• The expected base salary/wage range for this position is $34-$37/hr.
• 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.
Apply Now
Apply Now
Role Description
As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients’ lives, in a non-clinical environment. You can enjoy better work-life balance on a team that values collaboration and continuous learning while providing better health outcomes.
• Functions in a clinical review capacity to evaluate all cases that do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff.
• Reviews charts and analyzes clinical record documentation to approve services that meet clinical review criteria.
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff.
• Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes.
• Documents all communication with medical office staff and/or treating provider.
• Practices and maintains the principles of utilization management by adhering to policies and procedures.
• Participates in ongoing training programs to ensure quality performance in compliance with applicable standards and regulations, as well as being audited to ensure guidelines are applied appropriately.
Qualifications
• A current RN clinical license, active and in good standing, in your home state - Required
• Associate or Bachelors in Nursing (Must be a Registered Nurse) - Required
• You must be able to work a minimum of 30 hours/week - Required
• Strong interpersonal and communication skills - Required
• Proficient computer skills; must be able to talk and type simultaneously - Required
• 5+ years clinical experience - Preferred
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.
Benefits
• The expected base salary/wage range for this position is $34-$37/hr.
• 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.
Apply Now
Apply Now