Clinical Reviewer, Radiation Therapy ( WEST COAST HOURS)

What You’ll Be Doing

• Reviews Provider request for relevant and complete supporting documentation and requests for missing or additional documentation from providers per guidelines.
• Utilizes clinical guidelines approved by the Utilization Management Committee (UMC), the URN has the authority to authorize services or procedures.
• If a request does not meet established clinical guidelines for appropriateness and medical necessity, the request is sent to a physician reviewer.
• Verifies accuracy of codes and services and applies them accurately with appropriate documentation.
• Sets 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.

Qualifications

• 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.

Benefits

The expected base salary/wage range for this position is $38-39/hour. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.