Clinical Reviewer, Radiation Therapy

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🐻 Alaska, Arizona, +1 more states – Remote

🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote

💵 $38 - $39 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

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Evolent

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ 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

• To ensure the appropriate utilization of services act as an advocate for our members and to ensure the highest quality and cost-effective care. • Reviews Provider request for relevant and complete supporting documentation and requests for missing or additional documentation from providers per guidelines. • Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN has the authority to authorize services or procedures. • Verifies accuracy of codes and services and applies them accurately with appropriate documentation. • Ensures regulatory guidelines are met for timeliness and use of medical review criteria. • Acts with honor and integrity, serving as a role model for the company while establishing and maintaining professional relationships with Providers and office staff. • Complies with HIPAA requirements and all Evolent policies and procedures. • Performs other duties as assigned including and not limited to develop report data elements.

🎯 Requirements

• American Registry of Radiologic Technologists (ARRT) certification is current and in good standing in your home state. • 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, and demonstrate excellent problem-solving, critical thinking, and organizational skills. • Strong computer skills in Microsoft Office programs as well as EMR, SharePoint, and website navigation and email organization. • Required shift of 9:30AM - 6:00PM PST M-F, occasional weekends and holidays required with advance scheduling. • 2 - 4 years UM experience - Preferred

🏖️ Benefits

• Health insurance benefits