Clinical Reviewer, Nurse Practitioner/Physician Assistant – Oncology

Job not on LinkedIn

🕒 May 19

🇺🇸 United States – Remote

💵 $68 - $73 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 55%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Evolent

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🏥 Healthcare

☁️ SaaS

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

• Conduct initial clinical review of incoming cases and render authorization approval based on established clinical criteria • Escalate cases to a Field Medical Director when authorization cannot be approved during initial review • Act as a clinical liaison to providers, clients, and patients • Conduct clinical conversations with providers and office staff regarding medical necessity decisions • Maintain and operate Guideline Directed Treatment plans and communicate treatment recommendations to offices • Communicate requests for additional clinical information to ordering providers • Prepare cases for peer-to-peer discussions with Oncologists • Coordinate with UM staff for timely and accurate communication of clinical decisions • Complete UM projects and participate in site visit reviews • Maintain HIPAA confidentiality • Remain available to clinical and non-clinical administrative staff during initial and second-level screening • Act as an interdepartmental liaison between offices, departments, and committees • Serve as subject matter expert and participate in meetings with practices and/or payers • Work with the Director of Clinical Operations to ensure client satisfaction • Act with honor and integrity as a company role model • Perform other assigned duties

🎯 Requirements

• Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized degree program OR a master’s degree from a program accredited the ARC-PA • Minimum of three (3) to five (5) years’ experience in the practice of Oncology (required) • Knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred) • Current, unrestricted state PA or RN/NP license in medicine or required specialty • Licensed in Home State • If a PA, obtaining a passing score on a national certifying exam • Obtaining and maintaining required licenses, per business need • A clinical license, active and in good standing, in your home state is required • Strong clinical, management, communication, and organizational skills • Demonstrated leadership skills • Analytic skills • Energetic and curious with a passion for quality and value in health care • Required to pass skills proficiency test • Government issued photo ID required for identity verification • Comprehensive background check required • In-person I-9 verification required • May be subject to drug screening prior to employment • High speed internet over 10 Mbps at home • For call center employees, ability to plug directly into the home internet router • Perform all peer clinical review activities while located in a state or territory of the United States

🏖️ Benefits

• Work/life balance • Flexible work arrangements • Autonomy • Health insurance benefits for qualifying employees • Equal opportunity employment • Reasonable accommodations for individuals with disabilities