[Hiring] Clinical Reviewer, Nurse @Evolent

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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 tot his job Apply To this Job