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.
- Achieved a 100% score two years in a row on the
Human Rights Campaign's Corporate Equality Indexmaking us a best place to work for LGBTQ+ equality.
- Named to Parity.org’s
2020 list of the best companies for women to advance.
- Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.
- Published an annual
DE&I reportto share our progress on how we’re building an equitable workplace.
What You’ll Be Doing:
What You’ll Be Doing:
The LPN/LVN Associate, Clinical Operations, is an introductory role to Utilization Management. In this position, you will be trained on all aspects of Utilization Management at New Century Health and progress in your responsibilities to complete additional clinical tasks allowed within your licensure. This role is responsible for processing medical treatment requests in accordance with departmental policies, regulatory requirements, and client contractual agreements. Along with providing exceptional customer service, this role is required to meet performance metrics to ensure service level agreements are met. This role routinely contacts the physician’s offices, Health Plans, or patients to complete medical treatment requests. Answers and resolves incoming telephone, fax, and email inquiries regarding authorization requests.
In this role, you will compile and review the medical information for treatment requests, assist with obtaining missing clinical information, dose rounding, PDL’s, and other clinical tasks to support the New Century Health Utilization Review Nurse and Physician Reviewer. Complies with current URAC standards as they relate to this position.
The Experience You’ll Need (Required):
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.
- LPN or LVN license required for the state of employment.
- Ability to balance workload and prioritize assignments.
- Ability to identify problems and recommend solutions.
- Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel.
- Highly organized with ability to multi-task in a fast-paced environment and able to demonstrate excellent problem solving and critical thinking skills.
- Exceptional attention to detail and able to perform consistent work product validation.
- Presents a courteous and competent demeanor to our clients and teammates within the various levels of personnel in both clinical and non-clinical environments.
- Ability to work nights and weekends, as necessary.
- Performs other duties as assigned.
Finishing Touches (Preferred):
- UR Certification of Completion of the Utilization Review 101 Course for Licensed Nurses or prior experience with Utilization Management.
Technical Requirements:
Currently, Evolent employees work remotely temporarily due to COVID-19. As such, 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 committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.
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 $, 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.
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