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Occupational Therapist- Initial Clinical Reviewer- (50% Of Hours Between 4:00-11:00 Pm Cst)

Company

Evolent Health
Address , Remote
Employment type FULL_TIME
Salary $33 an hour
Expires 2023-06-18
Posted at 1 year ago
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:
  • Publish an annual DE&I report to share our progress on how we’re building an equitable workplace.
  • 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.
  • 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.
  • Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts.
  • 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:
Job Summary
Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process.
Schedule Requirements
  • Full-time- 40 hours (50% of hours must be worked 4-11 pm CST, the other hours can be 7-4 CST)

  • Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations.
  • In states where required, refers all cases that an approval cannot be rendered to the Physician Clinical Reviewer. In States where allowed, will make denial determinations as a specific case warrants.
  • Practices and maintains the principles of utilization management by adhering to policies and procedures.
  • Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria.
  • Documents all communication with medical office staff and/or treating provider.
  • Conducts regular audits, as assigned, to ensure guidelines are applied appropriately.
  • Converses with medical office staff in order to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale.
  • Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff.
  • Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plans required timeframes.
The Experience You’ll Need (Required):
  • An occupational therapist must hold a state license in occupational therapy and hold an occupational therapist degree from a ACOTE (Accreditation Council for Occupational Therapy Education) accredited educational program and pass the national certification examination.
  • 5+ years clinical
  • Strong interpersonal and communication skills.
  • Basic computer skills; must be able to talk and type simultaneously.
  • Current, unrestricted state licensure as an Occupational Therapist
Technical Requirements:
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 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 $33/hr, 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.