Job Title

Your Future Evolves Here Evolent partners with health plans and providers to enhance outcomes for those facing complex and costly health conditions. By bridging gaps across specialties and primary care, we ensure individuals receive the care and compassion we would want for our loved ones. At Evolent, we value a healthy work-life balance, flexible work options, and the autonomy needed for personal and professional growth. We believe that our best performance comes from an environment that supports individual well-being and encourages authenticity. Join us for the mission, and stay for the vibrant and engaging culture! What You'll Be Doing: As an Oncology Nurse Practitioner or Physician Assistant Reviewer, you will play a crucial role in administrative and clinical utilization management and quality improvement functions guided by our Chief Medical Officer. Key Responsibilities: Conduct initial clinical reviews of incoming cases, making authorization decisions based on established clinical criteria, or refer to the Field Medical Director when necessary. Act as a clinical liaison to providers, clients, and patients, as directed by the Chief Medical Officer's office. Engage in clinical discussions with providers and staff regarding medical necessity determinations. Maintain Guideline Directed Treatment plans and communicate treatment recommendations to offices. Request additional clinical information from ordering providers as needed. Prepare cases for peer-to-peer conversations with oncologists for cases that cannot be approved or modified by providers. Coordinate with Utilization Management (UM) staff to ensure timely communication regarding clinical decisions. Participate in UM projects and contribute to site visit reviews. Adhere to HIPAA confidentiality guidelines to safeguard patient information. Be available to both clinical and non-clinical staff during the screening processes. Serve as a liaison between departments, offices, and committees. Act as a subject matter expert and participate in meetings with practices and/or payers as necessary. Collaborate with the Director of Clinical Operations to ensure high client satisfaction. Conduct all peer clinical review activities while located within a state or territory of the United States. Uphold honor and integrity, serving as a positive role model for the company. Undertake additional duties as assigned. Qualifications: To excel in this role, candidates must successfully perform all essential duties. Required qualifications include: Master of Science in Nursing or Doctor of Nursing Practice (DNP) from an accredited program or a master's degree from an ARC-PA accredited program. Three (3) to five (5) years of experience in Oncology practice. Knowledge of regulatory standards, preferably with at least two years in a regulatory role. Licensure/Certification: Current, unrestricted state PA or RN/NP license in the relevant specialty. If a PA, a passing score on a national certifying exam is required. Must maintain necessary licenses per business needs. Active clinical license in good standing in your home state is mandatory. Skills and Abilities: Exceptional clinical, management, and communication skills. Proven leadership capabilities. Strong analytical skills. Enthusiasm for quality and value in healthcare. Must successfully pass a skills proficiency test. To ensure a secure hiring process, we implement various identity verification steps, including submission of a government-issued photo ID, with verification conducted during interviews. All candidates must undergo a comprehensive background check, in-person I-9 verification, and may face drug screening prior to employment. Misrepresentation will lead to immediate disqualification from consideration. Technical Requirements: All employees are expected to have a high-speed internet connection over 10 Mbps, and specifically for call center roles, the ability to connect directly to their home internet router. These requirements may change with any scheduled reopening of our office locations. Evolent is an equal opportunity employer and considers all qualified applicants 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 us for further assistance. The expected base salary for this position is $68-$73 per hour, inclusive of an eligible bonus component based on predefined performance criteria. Evolent offers a comprehensive benefits package, including health insurance, to qualifying employees. Compensation determinations reflect the skills and experience required for this position, which may vary based on individual qualifications. If you don't see your dream job here, we encourage you to submit your contact information and resume, and we will reach out if we find a great fit for you!