Coordinator, Utilization Management

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:

Job Description

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.

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, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our 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 generating 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 obtaining necessary information to address issues and problems.

• Meeting established Utilization Management Intake Objective and Key Results.

What You Bring:

• A high school diploma or GED is 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 is required.

• Ability to read, write and speak the English language fluently with patients and providers.

• Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors.

• Proficient using computer and Windows PC applications, which includes strong keyboard and navigation skills.

• Team oriented, demonstrates a strong work ethic and committed to productivity.

• Ability to sit for the majority of shift.

• Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment.

• The ability to connect to router via an ethernet cord (will be supplied with equipment) is required - our inbound/outbound calls application does not function on Wi-Fi, 4G, 5G, LTE, or Satellite internet services.

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 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.

Evolent 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. If you need reasonable accommodation to access the information provided on this website, please contact [email protected] for further assistance.

The expected base salary/wage range for this position is $20-25. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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