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

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions.

Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work.

That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing: The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Oncology is responsible for support and assistance for all Oncology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer.

ESSENTIAL DUTIES AND RESPONSIBILITIES : Conducts initial clinical review of incoming cases, rendering authorization approval based on established clinical criteria or escalating to a Field Medical Director if authorization cannot be approved during initial review.

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 Treatment plans including communicating with offices regarding treatment recommendation. 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 Oncologists. Res