Job Information
Evolent Health Director, UM in Helana, Montana
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:
As a Director, Utilization Management, you’ll work with your managers, front line clinical team, and matrix partners to ensure delivery on clinical excellence, performance guarantees, and efficiencies for our members, providers, and customers.
Collaboration Opportunities:
The Director, Utilization Management, will partner with a variety of different departments, including but not limited to, Medical Leaders, Partner Operations, Quality/Compliance, Implementations.
What You Will Be Doing:
Leadership of utilization management (UM) activities including design, implementation, and oversight of the operations. Operational activities include clinical review of prior authorization requests and support additional features such as training, appeals, and grievances for clients who have delegated UM.
Monitor all activities related to clinical review. Develop processes where indicated with direct oversight of centralized telephonic review process of all necessary utilization management components.
Partner with leadership to mentor staff. Jointly develop goals, objectives and define major roles. Implement processes, procedures and accountabilities for staff.
Responsible for achieving targeted utilization management results established by the department and/or client by monitoring and reporting the utilization management resources, implementing initiatives and educational processes.
Develop and adopt best practice methodologies and training programs for utilization management tools and techniques.
Provide recommendations on staffing plans, and assuring adequate allocation of resources for UM functions, and coordinating needs with market clinical leadership.
Collaborate with IT and Analytics teams for the development of required utilization management monitoring, initiatives, patient engagement and other outcomes initiatives.
Collaborate with other functional areas that interface with the utilization management department, including but not limited to claims, appeals, product, network development and care management.
Provide appropriate and timely management of complex clinical issues.
Mentor and support ongoing training and development of staff.
Promote a positive work environment by providing timely, specific and constructive performance feedback.
All other duties as assigned.
Qualifications - Required and Preferred:
Active clinical license such as Registered Nurse (RN), Physical/Occupational/Speech/Radiation Therapist or Chiro, Pharmacist - Required
Working knowledge of utilization management activities such as prior authorization, concurrent review, intake, appeals and grievances - Required
Five (5) to seven (7) years of progressive experience in utilization management - Required
Bachelor’s Degree in Nursing or related healthcare field (with Bachelor’s/Master’s Degree in Business Administration/Hospital Administration/ Public Health) - Preferred
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 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 recruiting@evolent.com for further assistance.
The expected base salary/wage range for this position is $130,000-$140,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. 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.
Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!
For more insights about Evolent Health, click on Life At Evolent (https://www.evolent.com/) to learn more!