• Job Description

  Req#: JR-911368

  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:

  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 experience as a radiation therapist- Strongly preferred

  • 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.

  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 $38-39/hour.. 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 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.

• About the company

  Evolent partners with payers and providers to dramatically reduce the total cost of care, improve clinical quality and simplify administration.

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