Your Future Evolves HereEvolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.We recognize employees that live our values, give back to our communities each year, and are champions for bringing our 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.What You’ll Be Doing:To ensure the appropriate utilization of services and act as an advocate for our members and to ensure the highest quality and cost effective care.Collaboration Opportunities:The Radiation Therapy Technologist Utilization Reviewer reports directly to the Supervisor, Utilization Management and Radiation Oncology Medical Director within the Utilization Management Department.What You Will Be Doing:
Reviews Provider request for relevant and complete supporting documentation.
Requests additional documentation per Evolent policy.
Utilizing clinical guidelines approved by Evolent Utilization Management Committee (UMC), the UR Reviewer Radiation Technologist 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. At no time can a UR Reviewer Rad Tech recommend an adverse determination.
Ensures regulatory guidelines are met for timeliness and use of medical review criteria.
Verifies accuracy of CPT codes and services and applies them accurately with appropriate documentation.
Establishes and maintains professional relationships with Providers and office staff for the purpose of education to establish a smooth operational flow of authorizations and referrals.
Complies with current Utilization Review Accreditation Committee (URAC) standards as they relate to this position.
Supports clinical initiatives as identified by the UM department and UMC.
Acts with honor and integrity, serving as a role model for the company.
Complies with HIPAA requirements and all Evolent policies and procedures.
Acts as an interdepartmental liaison between all Evolent offices, departments, and committees.
Ability to work occasional weekends and holidays, as necessary.
Performs other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Qualifications Required and Preferred:
American Registry of Radiologic Technologist (ARRT) certification current and in good standing - Required
Working knowledge of Radiation Oncology CPT codes- Preferred.
Prior Radiation Oncology coding audit experience- Preferred.
Strong computer skills in MS Excel and Word - Preferred.
Self-motivated, self-directed, team oriented, and responsible, with a positive attitude and a proactive style. Possesses the ability to operate in a highly variable work environment- Preferred.
Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel- Preferred.
Mandatory 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 .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.evolent.com/) to learn more!