[Hiring] Clinical Reviewer, Nurse Practitioner/Physician Assistant (Oncology) @Evolent

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Oncology is responsible for support and assistance for all Oncology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer. • Conducts initial clinical review of incoming cases, rendering authorization approval based on established clinical criteria or escalating to a Field Medical Director if authorization cannot be approved during initial review. • Acts as a clinical liaison to providers, clients, and patients as directed by the office of the Chief Medical Officer. • Engages in clinical conversations with providers and their office staff regarding medical necessity decisions. • Maintains and operates the Guideline Directed Treatment plans including communicating with offices regarding treatment recommendations. • Communicates need for additional clinical information to ordering providers. • Prepares cases which cannot be approved and which the provider will not modify or withdraw for P2P discussions with one of the Oncologists. • Coordinates with UM staff to ensure timely and accurate communication of clinical decisions. • Completes UM projects and participates in site visit reviews. • Respects and maintains HIPAA confidentiality guidelines. • Maintains availability to clinical and non-clinical administrative staff during performance of initial and second level screening. • Acts as an interdepartmental liaison between all offices, departments, and committees. • Serves as subject matter expert and participates in meetings as assigned with practices and/or payers. • Works with the Director of Clinical Operations to ensure client satisfaction. • Performs all peer clinical review activities while located in a state or territory of the United States. • Acts with honor and integrity, serving as a role model for the company. • Performs other duties as assigned. Qualifications • Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized degree program OR a master’s degree from a program accredited by the ARC-PA. • Minimum of three (3) to five (5) years’ experience in the practice of Oncology (required). • Knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred). Requirements • Current, unrestricted state PA or RN/NP license in medicine or required specialty. • Of a PA, obtaining a passing score on a national certifying exam. • Obtaining and maintaining required licenses, per business need. • Strong clinical, management, communication, and organizational skills. • Demonstrated leadership skills. • Analytic skills. • Energetic and curious with a passion for quality and value in health care. • Required to pass skills proficiency test. Benefits • Comprehensive health insurance benefits. • Expected base salary/wage range for this position is $68-74/hr. • This position is also eligible for a bonus component that would be dependent on pre-defined performance factors.