Physician Clinical Reviewer- Physical Medicine and Rehabilitation
Company: Evolent Health
Location: Bismarck
Posted on: September 19, 2023
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Job Description:
Your Future Evolves Here
New Century Health (NCH) has been transforming the delivery of
specialty care and driving radical cost and quality improvement
across the member journey for patients with cancer and
cardiovascular disease. As part of Evolent Health, we are on a bold
mission to change the health of the nation by changing the way
health care is delivered. Evolenteers make a difference wherever
they are, whether it is at a medical center, in the office, or
while working from home across 48 states. We empower you to work
from where you work best, which makes juggling careers, families,
and social lives so much easier. Through our recognition programs,
we also highlight employees who live our values, give back to our
communities each year, and are champions for bringing their whole
selves to work each day. If you're looking for a place where your
work can be personally and professionally rewarding, don't just
join a company with a mission. Join a mission with a company behind
it.
Why We're Worth the Application:
We continue to grow year over year.
Recognized as a leader in driving important diversity, equity, and
inclusion (DE&I) efforts
(https://www.evolenthealth.com/diversity) .
Achieved a 100% score two years in a row on the Human Rights
Campaign's Corporate Equality Index recognizing us as a best place
to work for LGBTQ+ equality.
Named to Parity.org's list of the best companies for women to
advance for 3 years in a row
(https://www.evolenthealth.com/about-us/press-releases/9328/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2022)
(2020, 2021 and 2022).
Continue to prioritize the employee experience and achieved a 90%
overall engagement score on our employee survey in May 2022.
Publish an annual DE&I report
(https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf)
to share our progress on how we're building an equitable
workplace.
What You'll Be Doing:
Do you crave an exciting new job that allows you to use your years
of clinical expertise while developing new skills and improving the
lives of others? If so, then this is the fit for you. As a
Physician Clinical Reviewer, you'll use your clinical knowledge to
provide evidence-based PMR reviews for patient care. You will be a
key member of the utilization management team and routinely
interact with physicians, leadership, management staff and other
Physician Clinical Reviewers (PCR's) whenever a physician`s input
is needed or required.
We provide you with all the computer equipment and training needed
to be successful in this role. And the best part, you get to reap
the benefits of a work-from-home role. If you are looking for a
better work life balance, we offer that at Evolent. We offer
part-time and full-time roles, so that you can choose a schedule
that works best for you!
Job Summary:
Serve as the Clinical Reviewer for cases that do not initially meet
the applicable medical necessity guidelines.
Discusses determinations (peer to peer phone calls) with requesting
physicians or ordering providers, when available, within the
regulatory timeframe of the request.
Provides clinical rationale for standard and expedited appeals.
Utilizes medical/clinical review guidelines and parameters to
assure consistency in the MD review process to reflect appropriate
utilization and compliance with SBU`s policies/procedures, as well
as Utilization Review Accreditation Commission (URAC) and National
Committee for Quality Assurance (NCQA) guidelines.
Aids and acts as a resource to Initial Clinical Reviewers.
Ensures documentation of all communications with medical office
staff and/or MD provider is recorded in a timely and accurate
manner.
Participates in on-going training per inter-rater reliability
process.
May assist the Senior Medical Director in research
activities/questions related to the Utilization Management process,
interpretation, guidelines and/or system support.
On a requested basis, may function as Medical Director for
selecting health plans or regions, assuming overall accountability
for utilization management while working in conjunction with the
Senior Medical Director.
The Experience You'll Need (Required):
DO/MD/MBBS Degree
Board Certified by and American Certifying Board for Physical
Medicine and Rehabilitation
Current, Unrestricted License in one or more states
Finishing Touches (Preferred):
5 years post residency experience
Strong verbal communication skills
Good Computer Skills
Must have practiced clinical medicine in the last 18 months.
Technical Requirements:
We require that all employees have the following technical
capability at their home: High speed internet over 10 Mbps, the
ability to plug in directly to the home internet router. These
at-home technical requirements are subject to change with any
scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all
qualified applicants equally without regard to race, color,
religion, sex, sexual orientation, gender identity, national
origin, veteran status, or disability status.
Compensation Range: The minimum salary for this position is $93.00,
plus benefits. Salaries are determined by the skill set required
for the position and commensurate with experience and may vary
above and below the stated amounts.
Don't see the dream job you are looking for? Drop off your contact
information and resume and we will reach out to you if we find the
perfect fit!
For more insights about Evolent Health, click on Life At Evolent
(https://www.evolenthealth.com/about-us/life-at-evolent) to learn
more!
Keywords: Evolent Health, Bismarck , Physician Clinical Reviewer- Physical Medicine and Rehabilitation, Healthcare , Bismarck, North Dakota
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