Clinical Reviewer, Radiation Therapy

This is a fully remote position, open to applicants anywhere in the world.

📋 Description

• Assesses provider requests for the necessary and complete supporting documentation and solicits any missing or additional documents from providers according to established guidelines.

• Using clinical guidelines endorsed by the Utilization Management Committee (UMC), the URN is empowered to authorize services or procedures.

• If a request fails to meet the predetermined clinical guidelines for appropriateness and medical necessity, it is referred to a physician reviewer.

• Confirms the accuracy of codes and services, ensuring they are applied correctly with the relevant documentation.

• Guarantees compliance with regulatory standards concerning timeliness and the application of medical review criteria.

• Conducts oneself with honor and integrity, serving as a role model within the company and fostering professional relationships with providers and office personnel.

• Adheres to HIPAA regulations along with all Evolent policies and procedures.

• Executes additional duties as assigned, including but not limited to developing report data elements.

⛳️ Requirements

• Current and in good standing American Registry of Radiologic Technologists (ARRT) certification in your home state.

• Demonstrates effective verbal and written communication skills, particularly over the phone, with the capacity to engage with various levels of personnel.

• Capable of thriving in a fast-paced environment while exhibiting strong problem-solving, critical thinking, and organizational abilities.

• Proficient in Microsoft Office applications, as well as EMR, SharePoint, and managing website navigation and email organization.

• Required work hours are from 9:30AM to 6:00PM PST, Monday to Friday, with occasional weekends and holidays required with prior notice.

• 2 to 4 years of experience in Utilization Management is preferred.

🏝️ Benefits

• Health insurance benefits