Clinical Reviewer, Nurse Practitioner/Physician Assistant (Oncology)(Evening Hours preferred)

About the role

Evolent is seeking a Nurse Practitioner or Physician Assistant with oncology expertise to serve as a Clinical Reviewer. This role supports utilization management and quality improvement functions within the office of the Chief Medical Officer, working with health plans and providers to optimize care for patients with complex and costly health conditions.

Responsibilities

• Conduct initial clinical review of incoming oncology 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 as directed by the Chief Medical Officer
• Engage in clinical conversations with providers and their office staff regarding medical necessity decisions
• Maintain and operate Guideline Directed Treatment plans, communicating treatment recommendations to provider offices
• Request additional clinical information from ordering providers as needed
• Prepare cases that cannot be approved and will not be modified or withdrawn for peer-to-peer discussions with oncologists
• Coordinate with utilization management staff to ensure timely and accurate communication of clinical decisions
• Complete utilization management projects and participate in site visit reviews
• Maintain HIPAA confidentiality guidelines
• Remain available to clinical and non-clinical administrative staff during initial and second-level screening
• Serve as an interdepartmental liaison between offices, departments, and committees
• Participate as a subject matter expert in meetings with practices and payers as assigned
• Work with the Director of Clinical Operations to ensure client satisfaction
• Perform all peer clinical review activities while located in a state or territory of the United States

Requirements

• Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized program, OR a master's degree from a program accredited by the ARC-PA
• Minimum of three to five years of experience in the practice of oncology
• Current, unrestricted state PA or RN/NP license in medicine or required specialty
• Active clinical license in good standing in your home state
• If a PA, a passing score on a national certifying exam
• Strong clinical, management, communication, and organizational skills
• Demonstrated leadership skills
• Analytic skills
• Required to pass skills proficiency test
• High-speed internet over 10 Mbps at home
• Ability to plug directly into the home internet router
• Pass comprehensive background check
• In-person I-9 verification
• May be subject to drug screening prior to employment
• Government-issued photo ID required for identity verification
• Identity verification during interviews; final interviews may require onsite attendance

Preferred Qualifications

• Knowledge of regulatory requirements with at least two years of experience in a regulatory role

Pay

Expected base salary: $68-$73 per hour

Benefits

• Comprehensive benefits package including health insurance for qualifying employees

Schedule

Evening hours preferred