The Clinical Reviewer is responsible for conducting clinical utilization management, rendering authorization decisions, and acting as a liaison between providers and the medical office. They also manage guideline-directed treatment plans and participate in quality improvement projects to ensure client satisfaction.
This role involves managing and supervising clinical staff performing utilization management reviews within the medical oncology specialty. The manager will also assist in developing strategic goals, coordinating training, and ensuring adherence to performance metrics.
Design and develop scalable backend services and data ingestion pipelines using Python and Azure cloud services. Collaborate with cross-functional teams in an Agile environment to maintain high-quality software and optimize existing systems.
The Lead Software Engineer will design, develop, and maintain enterprise-grade healthcare applications while providing technical leadership to the team. They are responsible for driving the software development lifecycle, ensuring code quality, and contributing to cloud-native modernization initiatives.
Develop and generate operational reports while identifying trends to support data-driven decision making. Assist operations teams by automating manual reporting processes and providing workload analysis for resource planning.
The Director of Strategic Accounts will serve as a consultative partner to manage and grow relationships with large health plan clients. They are responsible for driving value, managing contracts, and identifying strategic growth opportunities within their assigned book of business.
The Senior Analyst will analyze healthcare utilization and claims data to identify trends and cost drivers while developing actionable insights for stakeholders. They are responsible for maintaining financial models, creating dashboards, and automating reporting processes to support business objectives.
The Field Medical Director will serve as a subject matter expert for radiation oncology and imaging utilization management reviews. They will conduct peer-to-peer discussions with providers and ensure clinical documentation meets regulatory and accreditation standards.
The Staff Accountant will drive accounting operations for the India subsidiary, including lease accounting, SOX reviews, and monthly reporting. They will also collaborate with global leadership to manage accruals, financial disclosures, and statutory compliance requirements.
The Lead Payroll will manage end-to-end payroll operations, ensuring 100% accuracy, statutory compliance, and timely salary disbursement. They will also drive process improvements, manage vendor relationships, and provide actionable payroll insights to leadership.
The Associate Director oversees a team of analysts to deliver actionable insights and financial models that support Evolent's partners. They are responsible for leading analytics initiatives, ensuring model accuracy, and presenting data-driven recommendations to stakeholders.
Manage the day-to-day operational aspects of Medical Policy processes and support the publication of clinical guidelines. Collaborate with cross-functional teams to ensure the timely and accurate delivery of high-quality clinical guideline products.
Serve as a physician reviewer for Hip, Knee, and Shoulder surgery cases to determine medical necessity. Conduct peer-to-peer discussions with providers and ensure compliance with URAC and NCQA guidelines.
Manage the full lifecycle of SaaS applications with a focus on AI-driven automation and optimization of Atlassian platforms. Ensure security, governance, and regulatory compliance within a HIPAA-compliant environment.
Oversee actuarial quality and rigor across analytics and finance teams to ensure models are sound and defensible. Drive process improvements and workflow efficiencies to reduce manual effort and scale analytical outputs.
The Lead HRIS Analyst is responsible for the maintenance, enhancement, and optimization of the Workday HCM system. This includes configuring business processes, developing custom reports, and mentoring team members to improve HR efficiencies.
Serve as a specialty match reviewer for vascular cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while providing clinical rationale for appeals.
Lead and manage AI initiatives to transform healthcare operations, specifically focusing on the Auth Intelligence application. Coordinate between data science, clinical, and technical teams to translate model outputs into scalable product features.
The role involves providing data-driven financial and operational analyses to support strategic decision-making for executive leadership and the Board of Directors. Key duties include developing financial models, managing department budgets, and automating financial reporting tools.
Serve as a physician reviewer for imaging cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while providing clinical rationale for appeals.
Serve as a physician reviewer for imaging cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while providing clinical rationale for appeals.
Serve as a physician reviewer for imaging cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while providing clinical rationale for appeals.
Serve as a physician reviewer for imaging cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while providing clinical rationale for appeals.
Serve as a physician reviewer for imaging cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while documenting all clinical communications accurately.
Serve as a physician match reviewer for imaging cases to ensure medical necessity and compliance with URAC and NCQA guidelines. Conduct peer-to-peer discussions with providers to provide clinical rationale for determinations and appeals.
Serve as a physician match reviewer for imaging cases to determine medical necessity and conduct peer-to-peer discussions with providers. Ensure compliance with URAC and NCQA guidelines while providing clinical rationale for appeals.
The Lead HRIS Analyst is responsible for the maintenance, enhancement, and administration of the Workday HCM system. This includes collaborating with stakeholders to automate processes, designing custom reports, and mentoring team members.
The Engineer will manage, support, and optimize contact center technologies including PBX, ACD, IVR, and CTI systems. They will collaborate with cross-functional teams to diagnose technical issues and implement solutions that enhance operational performance and customer experience.
The Medical Director will conduct clinical reviews for oncology cases and engage with oncologists to promote value-based care and evidence-based practices. They will also collaborate with internal teams to design and execute clinical innovation initiatives and ensure compliance with quality standards.
The Field Medical Director will serve as the specialty-match reviewer for diagnostic cardiology cases that do not initially meet medical necessity guidelines, providing timely, clinically sound medical reviews. This role involves conducting peer-to-peer discussions with requesting physicians and providing evidence-based clinical rationale for standard and expedited appeals.
As a Field Medical Director in Radiology, you will review imaging cases for medical necessity and provide clinical rationale for determinations. You will also collaborate with physicians and assist in the utilization management process.
As a Field Medical Director in Cardiology, you will review cases that do not meet medical necessity guidelines and provide clinical rationale for appeals. You will also collaborate with physicians and assist in the utilization management process.
The Field Medical Director will provide expert reviews for cardiovascular cases and conduct peer-to-peer discussions with treating providers to ensure high-value care. They will also collaborate with leadership and clinical staff to address complex cases and support decision-making.
