Evolent
Healthcare Insurance • Healthcare • SaaS
Evolent is a healthcare company focused on improving care outcomes through its comprehensive management solutions across multiple medical specialties. They aim to enhance the patient care journey by offering coordinated services in areas like oncology, cardiology, musculoskeletal disorders, and primary care, while ensuring high-quality treatment pathways and cost management. Evolent believes every person deserves quality care, striving to align treatment guidelines and innovative approaches to meet patient needs effectively.
Clinical Reviewer, Nurse – Medical Oncology
Job not on LinkedIn
2 days ago
🇺🇸 United States – Remote
💵 $32 - $37 / hour
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔍🏥 Medical Reviewer
🦅 H1B Visa Sponsor
Evolent
Healthcare Insurance • Healthcare • SaaS
Evolent is a healthcare company focused on improving care outcomes through its comprehensive management solutions across multiple medical specialties. They aim to enhance the patient care journey by offering coordinated services in areas like oncology, cardiology, musculoskeletal disorders, and primary care, while ensuring high-quality treatment pathways and cost management. Evolent believes every person deserves quality care, striving to align treatment guidelines and innovative approaches to meet patient needs effectively.
📋 Description
• Perform precertification and prior approvals • Utilization review of outpatient procedures and ancillary services • Determine medical necessity and appropriateness of services using clinical review criteria • Document all review determinations and contact providers • Identify and refer quality issues and potential cases for Care Management
🎯 Requirements
• Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license • High School Diploma or equivalent required • Minimum of three years of direct clinical patient care • Minimum of one year of experience with medical management activities in a managed care environment • Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual) • Strong interpersonal, oral and written communication skills • Basic computer skills
🏖️ Benefits
• Health insurance benefits • Work/life balance • Flexibility to suit work to lives • Continuing education initiatives
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