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Lvn, Care Advisor, Utilization Management

Company

Evolent Health
Address , Remote
Employment type FULL_TIME
Salary $25 an hour
Expires 2023-06-12
Posted at 1 year ago
Job Description
Your Future Evolves Here
Evolent Health has 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:
  • Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index recognizing us as a best place to work for LGBTQ+ equality.
  • Publish an annual DE&I report to share our progress on how we’re building an equitable workplace.
  • Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts.
  • Named to Parity.org’s list of the best companies for women to advance for 3 years in a row (2020, 2021 and 2022).
  • We continue to grow year over year.
  • Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.
What You’ll Be Doing:
LVN, Care Advisor, Utilization Management
What You’ll Be Doing:
  • Collaborates with Claims, Quality Management and Provider Relations Departments as requested.
  • Other duties as assigned.
  • Performs accurate data entry to meet quality goals.
  • Identifies and refers cases that do not meet established clinical criteria to the Medical Director.
  • Accurately documents all review determinations and contacts providers and members according to established timeframes.
  • Identifies and refers quality issues to the Senior Director of Medical Management, or designee.
  • Determines medical necessity and appropriateness of services using clinical review criteria.
  • Acts as a member advocate by expediting the care process through the continuum, working in concert with the health care delivery team to maintain high quality and cost-effective care delivery.
  • Performs precertification and prior authorization reviews for a variety of outpatient and ancillary services.
  • Communicates information to other staff members as necessary/required.
  • Participates in continuing education initiatives.
  • Identifies potential cases for Care Management programs.
The Experience You Need (Required):
  • Minimum of three years of direct clinical patient care
  • Knowledge of health care resources within the community
  • Strong interpersonal, oral, and written communication skills.
  • High School Diploma or equivalent required.
  • Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)
  • Minimum of one year of experience with medical management activities in a managed care/ UM review environment
  • LPN or LVN- Licensed practical/vocational nurse (current and unrestricted)
  • Knowledge of managed care principles, HMO and Risk Contracting arrangements.
  • 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 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 $25.00, 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.