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

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.

Key Responsibilities

• Conducts initial clinical review of incoming cases, rendering authorization approval based on established clinical criteria or escalating to a Field Medical Director.
• 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 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.
• 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.

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.
• Passing score on a national certifying exam (for PA).
• Strong clinical, management, communication, and organizational skills.
• Demonstrated leadership skills.
• Analytic skills.
• Required to pass skills proficiency test.