Coordinator, UM Intake at Evolent Health in Work Home

Job description

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: The Coordinator, Intake Utilization Management at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements. SCHEDULE : 9:30 am - 6 pm Pacific ; with rotating weekends and holiday Collaboration Opportunities : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization Management. In support of our daily operations, this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs, and Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Associate Director and Director may also be available. What You Will Be Doing: Reviewing internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required. Entering data into a proprietary system generates cases for both the medical and behavioral health reviewers. These requests may be submitted via fax, email, or provider portal. Working directly with physician’s offices to obtain missing information required to submit a prior authorization request. Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion. Addressing requests promptly and courteously, honoring commitments, and displays persistence in obtaining necessary information to address issues and problems. Meeting established Utilization Management Intake Objectives and Key Results. Qualifications Required and Preferred: A high school diploma or GED - Required 1 – 3 years of experience in a Coordinator role either requesting or submitting prior authorization requests. Or relevant health care experience in claims or appeal & grievance. Required Previous background/experience with Oncology. Ability to read, write, and speak the English language fluently with patients and providers. - Required Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors. - Required Proficient in using computer and Windows PC applications, which includes strong keyboard and navigation skills. - Required Team-oriented demonstrates a strong work ethic and is committed to productivity. - Required Demonstrated ability to meet established goals while balancing a workload and prioritizing assignments in a remote environment. - Required To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that all employees have the following technical capabilit