Your Future Evolves HereEvolent 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:Our shared services team offers candidates the opportunity to make a meaningful impact by providing exceptional support to internal and external customers through positive interactions, and timely delivery of high-quality products. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes.Letter Writers are responsible for reviewing adverse determination decisions against criteria and policy, escalating questions to the physician reviewer, and creating letters that meet regulatory and Plain Language requirements. This position requires a manager who can synthesize various clinical and administrative requirements, communicate well with the team and clients, and write clearly.Responsibilities/Job Duties
Manages all operational aspects of the letter writing department.
Support the team to ensure adverse determinations are measured against appropriate criteria and medical policies.
Ensure appropriate Letter templates are used.
Maintain Letter Templates.
Support all team training efforts.
Ensure content of letters have decisions that are made, documented, and communicated clearly, and at the appropriate grade level when applicable.
Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director.
Communicates appropriate information to other staff members as necessary/required.
Participates in continuing education initiatives.
Collaborates with Claims, Quality Management and Provider Relations, or other Departments as requested.
Works with the physician reviewer to monitor the adverse determination process and ensure notification timeframes are met.
Have great written and verbal communication skills.
Support team efforts that effectively and clearly communicate adverse decisions to both members and providers.
Works with the appropriate team to ensure that decisions are made, documented, and communicated clearly.
Performs other duties as assigned.
Able to manage a diverse team.
Ensure appropriate staffing is maintained.
Manage time entry for all staff to ensure appropriate hours, salary and bonuses are entered timely.
Meet with the team of Letter Writers on a routine basis.
Qualifications
Licensed registered nurse or LVN/LPN (current and unrestricted)
Minimum of three years of direct clinical patient care
Minimum of one year of experience with medical management activities in a managed care environment
Excellent written skills
Knowledge of managed care principles, HMO and Risk Contracting arrangements.
Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)
Strong interpersonal, oral and written communication skills.
Possess basic computer skills.
Technical Requirements:We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, 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 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. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.The expected base salary/wage range for this position is $95,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. 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.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!