(Electrophysiology NP/PA) Clinical Reviewer, Nurse Practitioner/Physician Assistant

What You’ll Be Doing

The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer.

• Responsible for acting as a clinical liaison to providers, clients, and patients as directed by the office of the Chief Medical Officer.
• Responsible for clinical conversations with providers and their office staff regarding medical necessity decisions.
• Responsible for maintaining and operating the Guideline Directed Medical Therapy including communicating with offices recommendations regarding medical therapy.
• Responsible for communicating need for additional clinical information to ordering providers.
• Responsibility for prepping cases which cannot be approved and which the provider will not modify or withdraw for P2P discussions with one of the cardiologists.
• Responsible for coordinating with UM staff to ensure timely and accurate communication of clinical decisions.
• Responsible for completion of UM projects and participation in site visit reviews.
• Respect and maintain HIPAA confidentiality guidelines.
• Responsible for maintaining availability to clinical and non-clinical administrative staff during performance of initial and second level screening.
• Serves as an interdepartmental liaison between all Evolent offices, departments, and committees.
• Serve as subject matter expert and participate in meetings as assigned with practices and/or payers.
• Works with the Director of UM to ensure client satisfaction.
• Performs all peer clinical review activities while located in a state or territory of the United States.
• Acts with honor and integrity, serving as a role model for the company.
• Performs other duties as assigned.

Qualification Requirements

• Education and/or Experience: 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 five (5) years’ experience in the practice of EP cardiology (preferred) or primary care; knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred).
• Licenses/Certifications: Current, unrestricted state PA or RN/NP license in medicine or required specialty. Of a PA, obtaining a passing score on a national certifying exam Obtaining and maintaining required licenses in the states where NCH has business.
• Other Skills and Abilities: 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 To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment.