Job summary
Job post source
This job is directly from Evolent
Job overview
The Clinical Reviewer, Nurse at Evolent plays a crucial role in utilization management by evaluating clinical cases to ensure appropriate care and improve patient outcomes in a non-clinical setting.
Responsibilities and impact
The role involves reviewing clinical cases that fail initial authorization, analyzing medical records, collaborating with medical staff and Field Medical Directors, documenting communications, adhering to utilization management policies, and participating in ongoing training to maintain quality standards.
Compensation and benefits
The position offers an hourly wage of $34-$37 with eligibility for performance-based bonuses and comprehensive health insurance benefits, along with other benefits as part of the total compensation package.
Experience and skills
Candidates must have an unrestricted RN license in California or Oregon, an Associate or Bachelor's degree in Nursing, ability to work at least 30 hours per week, strong communication skills, proficiency in computer use, and preferably 5+ years of clinical experience.
Career development
The job emphasizes continuous learning and collaboration within a supportive team environment, promoting professional growth through ongoing training and quality performance audits.
Work environment and culture
Evolent values work-life balance, flexibility, diversity, inclusion, and supports employees to bring their whole selves to work in a collaborative and compassionate environment.
Company information
Evolent partners with health plans and providers to improve outcomes for complex and costly health conditions by integrating care across specialties and primary care, focusing on compassionate and coordinated healthcare delivery.
Team overview
The Clinical Reviewer, Nurse will work closely with leadership, other clinical reviewers, providers, office staff, and Field Medical Directors in a collaborative team setting.
Job location and travel
The position requires remote work with specific technical requirements including high-speed internet and direct router connection for call center functions, with potential changes depending on office reopening.
Unique job features
This role offers a meaningful impact on patient care in a non-clinical environment with a focus on utilization management and quality standards, supported by medical directors and a flexible, remote work setup.
Company overview
Evolent Health is a healthcare company that partners with healthcare providers and payers to improve clinical and financial performance. They offer a range of services, including value-based care solutions, population health management, and technology-enabled services, helping clients transition to value-based care models. Evolent generates revenue through service fees and performance-based contracts with healthcare organizations. Founded in 2011, the company has grown through strategic acquisitions and partnerships, establishing itself as a key player in transforming healthcare delivery. Understanding their focus on innovation and collaboration is crucial for candidates considering a role at Evolent.
How to land this job
Position your resume to highlight your current unrestricted RN license in California or Oregon, emphasizing your clinical experience and ability to work remotely with required technical capabilities.
Focus on your skills in clinical review, utilization management, and your ability to communicate effectively with providers and medical office staff, showcasing any experience with chart review and quality of care monitoring.
Apply through multiple channels including Evolent’s corporate careers page and LinkedIn to maximize your application visibility and ensure you meet the minimum 30 hours/week availability.
Connect with current Clinical Reviewers or team members in the utilization management division at Evolent on LinkedIn; use ice breakers like asking about their experience balancing work-life flexibility at Evolent or inquiring how they stay updated on utilization management best practices.
Optimize your resume for ATS by incorporating keywords from the job description such as 'clinical review,' 'utilization management,' 'RN license,' 'patient care coordination,' and 'quality of care standards' to pass initial screenings.
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