Evolent Health Hagåtña Guam
3 months ago
Your Future Evolves Here
New Century Health (NCH) has been transforming the delivery of specialty care and driving radical cost and quality improvement across the member journey for patients with cancer and cardiovascular disease. As part of Evolent Health, we are on a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind... it.
Why We're Worth the Application:
- We continue to grow year over year.
- Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .
- Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index recognizing us as a best place to work for LGBTQ+ equality.
- Named to Parity.org's list of the best companies for women to advance for 3 years in a row (https://www.evolenthealth.com/about-us/press-releases/9328/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2022) (2020, 2021 and 2022).
- Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.
- Publish an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we're building an equitable workplace.
What You'll Be Doing:
What You'll Be Doing:
- Reviews Provider request for relevant and complete supporting documentation.
- Requests additional documentation per New Century Health (NCH) policy.
- Utilizing clinical guidelines approved by NCH 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.
- Ensures regulatory guidelines are met for timeliness and use of medical review criteria.
- Verifies accuracy of codes and services and applies them accurately with appropriate documentation.
- Establishes and maintains professional relationships with Providers and office staff for the purpose of education to establish a smooth operational flow of authorizations and referrals.
- Educates and supports UM staff with medication requests, laboratory results and documentation of submissions per approved NCH policy guidelines.
- Complies with current URAC standards as they relate to this position.
- Supports clinical initiatives as identified by the UM department and UMC.
- Assists Chief Medical Officer (CMO), Medical Reviewers and the Clinical Specialist in the submission of developed and approved pathways sent to Information Technology.
- Assists the Director of UM, Medical Reviewers and CMO to develop report data elements necessary to track and trend utilization practices by provider, practice variation reports, reports to support quality initiatives, and elements to support NCH dashboard reports.
- Acts with honor and integrity, serving as a role model for the company.
- Complies with HIPAA requirements and all NCH policies and procedures.
- Acts as an interdepartmental liaison between all NCH offices, departments, and committees.
- Performs other duties as assigned.
The Experience You'll Need (required) :
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel.
- Able to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills.
- Performs multiple tasks efficiently and accurately, have exceptional attention to detail and perform consistent work product validation/QA.
- Self-motivated, self-directed, team oriented, and responsible, with a positive attitude and a proactive style. Possesses the ability to operate in a highly variable work environment.
- Presents a courteous and competent demeanor to our clients and teammates.
- Bachelor's degree in Nursing or HealthCare related field preferred. Unrestricted Registered Nurse (RN), LPN or LVN license required for the state of employment.
- Excellent customer service skills
- Strong computer skills in MS Excel and Word.
- Ability to easily navigate through website research.
- Ability to work nights and weekends, as necessary.
Finishing Touches (preferred):
- 2 - 4 years UM experience preferred.
- 2 - 3 years in an inpatient or outpatient setting highly preferred.
- Specialty certification preferred.
- Ability to review medical records and identify codes for claims processing preferred.
- Oncology and/or cardiology experience highly preferred.
Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, 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.
Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.
Evolent Health 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.
Compensation Range: The minimum salary for this position is $, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.
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For more insights about Evolent Health, click on Life At Evolent (https://www.evolenthealth.com/about-us/life-at-evolent) to learn more
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