Evolent Health jobs in Providence, RI - 66 jobs

Director, Client Value
Evolent 4.6
Evolent job in Providence, RI
**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:** **Director, Client Value** **About Evolent** Evolent Health partners with health plans and providers to drive clinical and financial performance, improve health outcomes, and deliver value-based care solutions. We are committed to transforming healthcare for the better. **Role Overview** The **Director, Client Value** will serve as a key member of the Client Value team, responsible for the effective management of value-based contracts in the Performance Suite. Under the direction of the VP, Client Value, the Director will have specific accountability for overall financial and medical expense performance for a segment of Evolent's Performance Suite portfolio. The Client Value team will track and monitor overall financial performance, underlying trends in cost and utilization, and operational and programmatic metrics. The Client Value team will leverage these data, internal and external client input, and overall Evolent enterprise strategic insights to develop client-specific performance plans. The Director will play a role in coordinating projects and programs that are identified as the highest value / highest priority topics for delivering cost and quality results. The Director will call together and facilitate cross-functional teams across clinical, product, finance, strategy, and more. Example programs and initiatives that may fall within a client specific performance plan may include: partnering with practices to improve in-clinic workflows, design of population-wide clinical programs that drive improved cost and quality outcomes, establishment of incentive programs and payment models that align provider economics with Evolent objectives, and more. The Director will have a variety of duties that may include: interfacing directly with clients to surface opportunities and co-design improvement projects, overseeing operational implementation of new pilots and programs, tracking performance on core UM and provider engagement metrics, and translating Client Value business plans into materials and messages appropriate for externally-facing client communications. Finance and Performance functions in the Performance Suite, Strategic Accounts, and Clinical Operations will be key partners for the Client Value team. Market-embedded resources that interface directly with provider practices and client teams will report in and be part of the overall Client Value team. **Key Responsibilities** + **Client Value Strategy:** Participate in the development of strategies to maximize client value and satisfaction across Evolent's portfolio. Support client-specific MER performance plans that represent performance on Evolent's core condition management solutions, as well as local / market-specific solutions that together ensure each Performance Suite client achieves its performance targets. + **Performance Oversight:** Monitor and report on client performance metrics, proactively identifying opportunities for improvement. Regularly monitor and utilize all available financial and analytic reporting. Assist in the development of client-facing communications related to Evolent performance. + **Operational Excellence** : Collaborate with implementation and operations teams to ensure successful product deployment and adoption; monitor product performance and provider satisfaction metrics to drive continuous improvement + **Cross-Functional Leadership:** Collaborate with internal teams (clinical, operations, analytics, and product) to deliver integrated solutions. Partner with Performance Suite and Solution Strategy teams to identify clients and market where new programs and innovations can be piloted. + **Collaboration:** Optimize partnership with rest of Client Value team, ensure appropriate division of work, ensure appropriate collaboration and communication. + **Executive Communication:** Present value outcomes and strategic recommendations to client executives and Evolent leadership. + **Team management:** Oversee a team of market-specific professionals; ensure highest priority initiatives are appropriately staffed and resourced; provide direction, support, and mentorship to support performance and development of the Client Value team. + **Team Culture:** Steward a culture of integrity, inclusion, accountability, and teamwork within the Client Value team and with Performance Suite and Evolent more broadly. **Qualifications** + **Experience:** 5-8+ years in healthcare, consulting, or client management roles, with a proven track record of delivering measurable value. + **Leadership:** Strong executive presence and ability to influence at all organizational levels. + **Analytical Skills:** Expertise in interpreting complex data and translating insights into actionable strategies. + **Industry Knowledge:** Deep understanding of value-based care, health plan operations, and provider partnerships. + **Education:** Bachelor's degree required; advanced degree preferred. 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $120,000-130,000. 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!
$120k-130k yearly 3d ago

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Director, Strategic Accounts
Evolent 4.6
Evolent job in Providence, RI
**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:** **Director, Strategic Accounts** **Put your passion where it meets purpose!** Evolent attracts some of the brightest minds in health care. Surround yourself with talented, driven colleagues who share a passion for better health outcomes and a more connected care journey. We are hiring a **Director, Strategic Accounts** to join our Customer Team. This role is unique: you will work directly with one of Evolent's largest, growing health plan clients and lead account strategy and execution. You'll have direct oversight of sales pipeline and renewals. This position partners with a customer operations lead and as a dyad you'll oversee cross-functional business and operating teams managing key client priorities. This position is highly strategic, with a strong emphasis on **upsell/cross-sell opportunities by fostering relationships, solutioning and problem solving, and communicating value.** **Collaboration Opportunities** As a consultative leader, you will identify growth opportunities within health plan specialty management and Evolent. The Strategic Account Director will implement relationship best practices, deliver on strategic growth initiatives, and drive measurable value while increasing satisfaction across all levels of the partner organization. **What You'll Be Doing** + **Strategically manage** an assigned book of business to achieve objectives in relationship development, growth, retention, and customer success. + **Identify and pursue growth opportunities** through analysis, customer research and active listening. Manage deal cycle including pitch, scope development, pricing, contract negotiations and implementation readiness. + **Define and facilitate execution of multi-year account strategy** including strategic account planning, relationship mapping, competitive analysis, and issue resolution. + **Manage and optimize contracts and performance** , by effectively partnering with Customer Operations dyad partner and Business Line leaders-ensuring compliance with SLAs, maximizing savings through benefit analysis, and adhering to legal and regulatory requirements. + **Articulate Evolent's value proposition and performance** across products and services, establishing fluency in key value drivers and measurements and opportunities for improvement + **Cultivate trusted relationships** with key executives, including C-level stakeholders, and serve as a liaison between internal and external teams. + **Leverage data-driven insights** to run efficient meetings and work sessions with clients and subject matter experts. + **Develop best-in-class presentations** and narratives for senior stakeholder meetings. + **Serve as an ambassador** for partner culture within Evolent and act as the go-to expert on client priorities. **Preferred Experience** + Bachelor's degree or equivalent work experience. + 5+ years of broad-based health care experience, health plan, and/or specialty or value-based care experience preferred + Strong **consulting background** with expertise in strategy, business development, and value based arrangements. + Ability to find creative solutions in a dynamic, evolving environment. + Exceptional communication and influencing skills at all organizational levels, including C-suite. + High emotional intelligence and ability to connect with diverse stakeholders. + **Travel:** Up to 40% within the U.S. and U.S. territories. 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $-. 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!
$105k-184k yearly est. 11d ago
Clinical Reviewer, Occupational Therapy
Evolent 4.6
Evolent job in Providence, RI
**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 an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. Collaboration Opportunities: + Routinely interacts with leadership and management staff, Physicians, and and other CR's whenever input is needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job Description + Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. + Conducts regular audits, as assigned, to ensure guidelines are applied appropriately. + In states where required, refers all cases that an approval cannot be rendered to the Physician Clinical Reviewer. In States where allowed, will make denial determinations as a specific case warrants. + Converses with medical office staff in order to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale. + Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plans required timeframes. + Documents all communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations. **The Experience You'll Need (Required):** + Current, unrestricted state licensure as a Occupational Therapist + A occupational therapist must hold a state license in occupational therapy and hold an occupational therapy degree from an accredited education program and pass the national certification examination. + 5+ years clinical experience is preferred + Strong interpersonal and communication skills. + Strong clinical, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of disciplinary or legal action by a state medical board 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $. 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!
$51k-64k yearly est. 3d ago
Analyst, Application Support
Evolent 4.6
Evolent job in Providence, RI
**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:** The **Analyst, Application Support** is a highly motivated person with excellent communication and interpersonal skills to interact with internal/external teams and application users and help trouble shoot/resolve issues reported by various departments within Evolent. This person will provide high quality operational, technical, and systems support to preserve customer satisfaction and internal business functions to aid in minimizing recurrence of incidents. **What You Will Be Doing:** + Provide first-level support, including problem replication, triage, and resolution of issues, the majority of which are associated with Standard Operating Procedures (SOPs) + Provide accurate and timely resolution of issues, and escalation when necessary + Ensure that Service Level Agreements (SLAs) are met + Maintain and update documentation related to operations and support processes within Confluence + Contributes to improvement of existing processes and identification of new processes and technical alternatives to resolve problems + Collaborate with team members and business functions to troubleshoot and resolve support tickets + Respond to escalations and incidents, providing support toward resolution, and notifying stakeholders of progress during business hours and outside of normal business hours (on-call support) + Contribute to writing T-SQL code and tools to assist Level 1 support to diagnose and resolve incidents + Execute SQL scripts to generate reports, troubleshoot data issues, and fulfill database support tasks + Perform ad-hoc task and analysis for the support team as needed Perform quarterly user access audit **Qualifications - Required:** + Bachelor's degree in computer science, IT- related degree or comparable experience + 1+ year(s) of progressive experience within application support/IT operations organizations + 1+ year(s) experience with T-SQL, ability to view and write T-SQL code for triage and investigation + Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas. + Basic knowledge of web application functionality and fundamental Infrastructure knowledge of computer systems. + Collaborative working style with the ability to work across different organizations and personalities + Ability to work unsupervised and a self-starter who seeks improvements without direction + **This role is Monday- Friday from 9:00 am to 6:00pm, CST, MST or PST. with some flexibility. Additionally rotating on-call support, including after-hours, weekends and holidays.** **Qualifications - Preferred:** + Experience in a healthcare-related field + Familiarity with JIRA, Confluence, Microsoft Azure - Application Insights + JIRA Service Desk ticketing system/Confluence experience 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $28.00 to $31.00. 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!
$28-31 hourly 45d ago
Clinical Reviewer, Nurse Practitioner/Physician Assistant (Vascular Surgery)
Evolent 4.6
Evolent job in Providence, RI
**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:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned. + Responsible for acting as a clinical liaison to providers, clients, and patients as directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers and their office staff regarding medical necessity decisions. + Responsible for maintaining and operating the Guideline Directed Medial Therapy including communicating with offices recommendations regarding medical therapy. + Responsible for communicating need for additional clinical information to ordering providers. + Responsibility for prepping cases which cannot be approved and which the provider will not modify or withdraw for P2P discussions with one of the Vascular Surgeons or Cardiologists. + Responsible for coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation in site visit reviews. + Respect and maintain HIPAA confidentiality guidelines. + Responsible for maintaining availability to clinical and non-clinical administrative staff during performance of initial and second level screening + Acts as an interdepartmental liaison between all New Century Health offices, departments, and committees. + Serve as subject matter expert and participate in meetings as assigned with practices and/or payers. + Will work with the Director of UM to ensure client satisfaction. + Perform 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. QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE: 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 the ARC-PA. Minimum of five (5) years' experience in the practice of Vacular Surgery (preferred) or primary care; knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred). LICENSE/CERTIFICATION: 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 in the states where NCH has business OTHER SKILLS and ABILITIES: 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 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. 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** ************************** **for further assistance.** The 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. 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!
$68-74 hourly 4d ago
Software Engineer
Evolent 4.6
Evolent job in Providence, RI
**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:** Responsibilities + Design, develop, test, and maintain software applications using modern programming languagesand frameworks. + Collaborate with product managers, designers, and other engineers to translate requirementsinto technical specifications. + Write clean, maintainable, and efficient code, following best practices and coding standards. + Participate in code reviews to ensure code quality, functionality, and maintainability. + Troubleshoot, debug, and resolve technical issues and bugs in a timely manner. + Optimize applications for maximum performance, scalability, and reliability. + Contribute to the continuous improvement of development processes, tools, and + methodologies. + Stay up-to-date with emerging technologies and industry trends, and apply them to improve ourproducts and solutions. Requirements + Bachelor's degree in Computer Science, Software Engineering, or a related field, or equivalent + practical experience. + Proven experience in software development using languages such as C#, Java, Python, JavaScript,etc. + Strong understanding of software design principles, algorithms, and data structures. + Experience with front-end frameworks (e.g., React, Angular, Vue) and/or back-end technologies(e.g., Node.js, Django, Spring). + Familiarity with version control systems such as Git and collaborative coding workflows. + Experience with cloud platforms (e.g., Azure, AWS, Google Cloud) and containerization tools + (e.g., Docker, Kubernetes). + Ability to write unit, integration, and end-to-end tests to ensure code quality and reliability. + Excellent problem-solving skills and the ability to work independently and as part of a team. + Strong communication skills with the ability to articulate technical concepts to both technicaland non-technical stakeholders. 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $73,200 - 102,500. 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!
$73.2k-102.5k yearly 2d ago
Clinical Reviewer, Nurse (Medical Oncology)
Evolent 4.6
Evolent job in Providence, RI
**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:** **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:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed within the **RN/LVN/LPN** scope of practice, under the Medical Director's direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum and working in concert with the health care delivery team to maintain high-quality, cost-effective care delivery. + Perform pre-certification utilization reviews of **Oncology treatment requests** + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review rationales and determinations. + Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director. + Appropriately identifies and refers quality issues to UM Leadership. + Collaborates with physicians and other providers to facilitate the provision of services throughout the health care continuum. + Performs accurate data entry. + Communicates appropriate information to other staff members as necessary/required. + Participates in continuing education initiatives. + Availability on some weekends and holidays may be required. + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license. + High School Diploma or equivalent required + Minimum of three years of direct clinical patient care (acute, inpatient, or critical care setting); strongly prefer direct Oncology experience. + Strong computer skills, including MS Office Suite + Strong interpersonal, oral, and written communication skills. + Availability for weekend holiday rotation. **Finishing Touches (Preferred):** + Experience with clinical decision-making criteria sets (i.e., Milliman, InterQual) + Minimum of one year of experience with medical management activities in a managed care environment + UM/UR experience + Clinical experience in Oncology, ICU, ED, or other critical care environment + Remote work experience 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $32-$37 /hr. 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!
$32-37 hourly 40d ago
Director, Service Excellence
Evolent 4.6
Evolent job in Providence, RI
**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 **Director, Service Excellence** Evolent is looking to hire a Director of Service Excellence. This individual will serve on a central team within the customer organization focused on ensuring that we deliver best-in-class service to our customers. The director will be a key connection point into cross-functional teams, representing the customer team on key issues and initiatives representing multiple partners. **Who You'll Be Working With:** The person in this role will be responsible for managing incident response, ensuring that we are addressing issues in a timely manner, monitoring outbound documents to facilitate clear and consistent messaging around our value and performance, leveraging internal SME's to educate customer-facing teams on key initiatives that drive value, and ensuring that we are providing transparent and proactive communication to our customers. **What You'll Be Doing:** + Manage voice of customer insight gathering through survey administration and customer specific primary research + Facilitate internal forums to promote alignment and accountability across internal teams (e.g., SLA timelines, product performance and value, data monitoring / platform issues, etc.) + Serve as the main customer point of contact for key initiatives with a focus on solutioning, streamlining processes and working cross-functionally to ensure timely execution + Coordinate customer communication (payer and provider) on key initiatives, projects, or issues/incidents that impact service delivery + Develop an "issue resolution" playbook, promoting consistent definitions of problem types and standardizing solutioning + Ensure SLA's are maintained via a central database, instilling best practices for monitoring and managing across the customer org + Monitor internal issue ticketing system / reporting to ensure key customer issues are being addressed in a timely manner **The Experience You'll Need (Required):** + 5+ years of experience in account management or client services role in digital health, healthcare, payer + Previous experience managing a team of direct reports + Strong track record of high client satisfaction, growth and retention + Strong verbal, written and presentation skills; ability to communicate clearly and influence internal and external stakeholders + Strong analytical skills; ability to understand data and present information accordingly + Experience working in a cross-functional capacity + Strong leadership and effective problem abilities; must be able to develop and grow relationships with executive leaders, and internal cross-functional teams 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $-. 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!
$120k-180k yearly est. 3d ago
Field Medical Director, Cardiology
Evolent 4.6
Evolent job in Boston, MA
**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 Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. **Qualifications - Required and Preferred:** + MD/DO/MBBS Degree + Current, unrestricted clinical license in medicine or required specialty + Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs + Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Minimum of five (5) years' experience in the practice of Cardiology is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $120-$135/hr. 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!
$120-135 hourly 60d+ ago
Clinical Reviewer, Occupational Therapy
Evolent 4.6
Evolent job in Boston, MA
**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 an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. Collaboration Opportunities: + Routinely interacts with leadership and management staff, Physicians, and and other CR's whenever input is needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job Description + Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. + Conducts regular audits, as assigned, to ensure guidelines are applied appropriately. + In states where required, refers all cases that an approval cannot be rendered to the Physician Clinical Reviewer. In States where allowed, will make denial determinations as a specific case warrants. + Converses with medical office staff in order to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale. + Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plans required timeframes. + Documents all communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations. **The Experience You'll Need (Required):** + Current, unrestricted state licensure as a Occupational Therapist + A occupational therapist must hold a state license in occupational therapy and hold an occupational therapy degree from an accredited education program and pass the national certification examination. + 5+ years clinical experience is preferred + Strong interpersonal and communication skills. + Strong clinical, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of disciplinary or legal action by a state medical board 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $. 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!
$61k-75k yearly est. 3d ago
Analyst, Application Support
Evolent 4.6
Evolent job in Boston, MA
**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:** The **Analyst, Application Support** is a highly motivated person with excellent communication and interpersonal skills to interact with internal/external teams and application users and help trouble shoot/resolve issues reported by various departments within Evolent. This person will provide high quality operational, technical, and systems support to preserve customer satisfaction and internal business functions to aid in minimizing recurrence of incidents. **What You Will Be Doing:** + Provide first-level support, including problem replication, triage, and resolution of issues, the majority of which are associated with Standard Operating Procedures (SOPs) + Provide accurate and timely resolution of issues, and escalation when necessary + Ensure that Service Level Agreements (SLAs) are met + Maintain and update documentation related to operations and support processes within Confluence + Contributes to improvement of existing processes and identification of new processes and technical alternatives to resolve problems + Collaborate with team members and business functions to troubleshoot and resolve support tickets + Respond to escalations and incidents, providing support toward resolution, and notifying stakeholders of progress during business hours and outside of normal business hours (on-call support) + Contribute to writing T-SQL code and tools to assist Level 1 support to diagnose and resolve incidents + Execute SQL scripts to generate reports, troubleshoot data issues, and fulfill database support tasks + Perform ad-hoc task and analysis for the support team as needed Perform quarterly user access audit **Qualifications - Required:** + Bachelor's degree in computer science, IT- related degree or comparable experience + 1+ year(s) of progressive experience within application support/IT operations organizations + 1+ year(s) experience with T-SQL, ability to view and write T-SQL code for triage and investigation + Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas. + Basic knowledge of web application functionality and fundamental Infrastructure knowledge of computer systems. + Collaborative working style with the ability to work across different organizations and personalities + Ability to work unsupervised and a self-starter who seeks improvements without direction + **This role is Monday- Friday from 9:00 am to 6:00pm, CST, MST or PST. with some flexibility. Additionally rotating on-call support, including after-hours, weekends and holidays.** **Qualifications - Preferred:** + Experience in a healthcare-related field + Familiarity with JIRA, Confluence, Microsoft Azure - Application Insights + JIRA Service Desk ticketing system/Confluence experience 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $28.00 to $31.00. 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!
$28-31 hourly 45d ago
Clinical Reviewer, Nurse Practitioner/Physician Assistant (Vascular Surgery)
Evolent 4.6
Evolent job in Boston, MA
**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:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned. + Responsible for acting as a clinical liaison to providers, clients, and patients as directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers and their office staff regarding medical necessity decisions. + Responsible for maintaining and operating the Guideline Directed Medial Therapy including communicating with offices recommendations regarding medical therapy. + Responsible for communicating need for additional clinical information to ordering providers. + Responsibility for prepping cases which cannot be approved and which the provider will not modify or withdraw for P2P discussions with one of the Vascular Surgeons or Cardiologists. + Responsible for coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation in site visit reviews. + Respect and maintain HIPAA confidentiality guidelines. + Responsible for maintaining availability to clinical and non-clinical administrative staff during performance of initial and second level screening + Acts as an interdepartmental liaison between all New Century Health offices, departments, and committees. + Serve as subject matter expert and participate in meetings as assigned with practices and/or payers. + Will work with the Director of UM to ensure client satisfaction. + Perform 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. QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE: 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 the ARC-PA. Minimum of five (5) years' experience in the practice of Vacular Surgery (preferred) or primary care; knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred). LICENSE/CERTIFICATION: 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 in the states where NCH has business OTHER SKILLS and ABILITIES: 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 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. 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** ************************** **for further assistance.** The 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. 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!
$68-74 hourly 4d ago
Director, Client Value
Evolent 4.6
Evolent job in Boston, MA
**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:** **Director, Client Value** **About Evolent** Evolent Health partners with health plans and providers to drive clinical and financial performance, improve health outcomes, and deliver value-based care solutions. We are committed to transforming healthcare for the better. **Role Overview** The **Director, Client Value** will serve as a key member of the Client Value team, responsible for the effective management of value-based contracts in the Performance Suite. Under the direction of the VP, Client Value, the Director will have specific accountability for overall financial and medical expense performance for a segment of Evolent's Performance Suite portfolio. The Client Value team will track and monitor overall financial performance, underlying trends in cost and utilization, and operational and programmatic metrics. The Client Value team will leverage these data, internal and external client input, and overall Evolent enterprise strategic insights to develop client-specific performance plans. The Director will play a role in coordinating projects and programs that are identified as the highest value / highest priority topics for delivering cost and quality results. The Director will call together and facilitate cross-functional teams across clinical, product, finance, strategy, and more. Example programs and initiatives that may fall within a client specific performance plan may include: partnering with practices to improve in-clinic workflows, design of population-wide clinical programs that drive improved cost and quality outcomes, establishment of incentive programs and payment models that align provider economics with Evolent objectives, and more. The Director will have a variety of duties that may include: interfacing directly with clients to surface opportunities and co-design improvement projects, overseeing operational implementation of new pilots and programs, tracking performance on core UM and provider engagement metrics, and translating Client Value business plans into materials and messages appropriate for externally-facing client communications. Finance and Performance functions in the Performance Suite, Strategic Accounts, and Clinical Operations will be key partners for the Client Value team. Market-embedded resources that interface directly with provider practices and client teams will report in and be part of the overall Client Value team. **Key Responsibilities** + **Client Value Strategy:** Participate in the development of strategies to maximize client value and satisfaction across Evolent's portfolio. Support client-specific MER performance plans that represent performance on Evolent's core condition management solutions, as well as local / market-specific solutions that together ensure each Performance Suite client achieves its performance targets. + **Performance Oversight:** Monitor and report on client performance metrics, proactively identifying opportunities for improvement. Regularly monitor and utilize all available financial and analytic reporting. Assist in the development of client-facing communications related to Evolent performance. + **Operational Excellence** : Collaborate with implementation and operations teams to ensure successful product deployment and adoption; monitor product performance and provider satisfaction metrics to drive continuous improvement + **Cross-Functional Leadership:** Collaborate with internal teams (clinical, operations, analytics, and product) to deliver integrated solutions. Partner with Performance Suite and Solution Strategy teams to identify clients and market where new programs and innovations can be piloted. + **Collaboration:** Optimize partnership with rest of Client Value team, ensure appropriate division of work, ensure appropriate collaboration and communication. + **Executive Communication:** Present value outcomes and strategic recommendations to client executives and Evolent leadership. + **Team management:** Oversee a team of market-specific professionals; ensure highest priority initiatives are appropriately staffed and resourced; provide direction, support, and mentorship to support performance and development of the Client Value team. + **Team Culture:** Steward a culture of integrity, inclusion, accountability, and teamwork within the Client Value team and with Performance Suite and Evolent more broadly. **Qualifications** + **Experience:** 5-8+ years in healthcare, consulting, or client management roles, with a proven track record of delivering measurable value. + **Leadership:** Strong executive presence and ability to influence at all organizational levels. + **Analytical Skills:** Expertise in interpreting complex data and translating insights into actionable strategies. + **Industry Knowledge:** Deep understanding of value-based care, health plan operations, and provider partnerships. + **Education:** Bachelor's degree required; advanced degree preferred. 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $120,000-130,000. 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!
$120k-130k yearly 3d ago
Software Engineer
Evolent 4.6
Evolent job in Boston, MA
**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:** Responsibilities + Design, develop, test, and maintain software applications using modern programming languagesand frameworks. + Collaborate with product managers, designers, and other engineers to translate requirementsinto technical specifications. + Write clean, maintainable, and efficient code, following best practices and coding standards. + Participate in code reviews to ensure code quality, functionality, and maintainability. + Troubleshoot, debug, and resolve technical issues and bugs in a timely manner. + Optimize applications for maximum performance, scalability, and reliability. + Contribute to the continuous improvement of development processes, tools, and + methodologies. + Stay up-to-date with emerging technologies and industry trends, and apply them to improve ourproducts and solutions. Requirements + Bachelor's degree in Computer Science, Software Engineering, or a related field, or equivalent + practical experience. + Proven experience in software development using languages such as C#, Java, Python, JavaScript,etc. + Strong understanding of software design principles, algorithms, and data structures. + Experience with front-end frameworks (e.g., React, Angular, Vue) and/or back-end technologies(e.g., Node.js, Django, Spring). + Familiarity with version control systems such as Git and collaborative coding workflows. + Experience with cloud platforms (e.g., Azure, AWS, Google Cloud) and containerization tools + (e.g., Docker, Kubernetes). + Ability to write unit, integration, and end-to-end tests to ensure code quality and reliability. + Excellent problem-solving skills and the ability to work independently and as part of a team. + Strong communication skills with the ability to articulate technical concepts to both technicaland non-technical stakeholders. 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $73,200 - 102,500. 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!
$73.2k-102.5k yearly 2d ago
Managing Director, Strategic Accounts (California)
Evolent 4.6
Evolent job in Providence, RI
**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:** **What you'll be doing:** The Managing Director, Strategic Accounts role is a dynamic, fast paced position, serving as the single executive accountable for client health, strategy, success, and growth. This role provides the opportunity to own a book of client specific P&Ls including retention, expansion, and operational efficiency. It is a player coach role providing the opportunity to foster executive relationships at client accounts and lead a team of account directors and managers. **Who You'll Be Working With:** The Managing Director, Strategic Accounts embodies the Evolent value "Start by Listening," forging deep relationships and serving as a trusted C-suite advisor to Evolent's partners. This role also work in a highly cross-functiona capacity, including with key leaders and team members in our Operations and Provider Solutions teams. We are looking for a candidate with a strong entrepreneurial spirit to oversee strategic partnerships with a pool of large, multi-state and/or multi-line of business health plans. This role will report to Evolent's Chief Customer Officer **The Day-to-Day** + Serving as a strategic advisor and consultative partner, helping to identify opportunities for more impactful management of health plan's specialty care initiatives.; Managing the commercial process for these growth opportunities in collaboration with Business Development, Corporate Development and Operations leaders + Developing and orchestrating market-specific and enterprise performance initiatives; flagging risks for risk partner performance relative to financial goals + Managing a team of high-performing account leads, ensuring consistent market/client governance and appropriate allocation of team resources. + Taking responsibility for the satisfaction, retention, and growth of a portfolio of Evolent solutions across this account. Cultivating productive, trusted relationships with key partner executives and stakeholders + Owning the strategy and execution of the commercial process for contract management, negotiation, and renewals. Running regular Account Strategy Planning efforts, including relationship mapping, issue identification, and action planning + Proactively assessing, validating, and prioritizing partner needs on an ongoing basis, channeling input from partners into Evolent's product roadmap and strategy + With Operations and Provider Solutions teams, monitoring issue resolution and ensuring appropriate, timely follow up by Evolent team members; advocating on behalf of partner within Evolent to overcome challenges to partner value and ensuring Evolent addresses root causes of satisfaction issues + Advocating for partner culture, serving as an ambassador within Evolent and acting as the subject-matter-expert on partner priorities and getting things done within the partner organization **Qualifications:** + 10+ years in relationship management roles (consulting, enterprise sales, account management, etc.) + Bachelor's degree OR equivalent work experience. + Commercial / business development acumen to identify and close growth opportunities + Demonstrated ability to effectively communicate and present at all levels of the organization, including at the C-level. Influence through effective stories to emphasize the value proposition of the partnership. + Strong command of the financial elements of value-based care businesses and an ability to package this analysis into a compelling value proposition for specific growth opportunities and the partnership overall + A tenacious partnership ethos with a relentless focus on follow through and maintaining trust + The intellectual curiosity to get to the bottom of partner issues and opportunities and the willingness to roll up sleeves and work toward solutions in partnership with operations counterparts and centralized resources + Ability to manage heavy travel schedule, including ~3 days a week in-market at our partner organizations 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $160,000-180,000. 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!
$160k-180k yearly 4d ago
Field Medical Director, Oncology
Evolent 4.6
Evolent job in Boston, MA
**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 Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** · Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. **What You Will Be Doing:** · Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. · Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. · Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. · Aids and acts as a resource to Initial Clinical Reviewers. · Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. · May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. · Participates in on-going training per inter-rater reliability process. **Qualifications:** · MD/DO/MBBS · Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred · Current, unrestricted clinical license in medicine or required specialty · Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs · Active Board Certification in Adult Medical Oncology · Strong clinical, management, communication, and organizational skills · Energetic and curious with a passion for quality and value in health car · Computer Proficiency · Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. · No history of disciplinary or legal action by a state medical board 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $110-$125. 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!
$110-125 hourly 60d+ ago
Director, Service Excellence
Evolent 4.6
Evolent job in Boston, MA
**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 **Director, Service Excellence** Evolent is looking to hire a Director of Service Excellence. This individual will serve on a central team within the customer organization focused on ensuring that we deliver best-in-class service to our customers. The director will be a key connection point into cross-functional teams, representing the customer team on key issues and initiatives representing multiple partners. **Who You'll Be Working With:** The person in this role will be responsible for managing incident response, ensuring that we are addressing issues in a timely manner, monitoring outbound documents to facilitate clear and consistent messaging around our value and performance, leveraging internal SME's to educate customer-facing teams on key initiatives that drive value, and ensuring that we are providing transparent and proactive communication to our customers. **What You'll Be Doing:** + Manage voice of customer insight gathering through survey administration and customer specific primary research + Facilitate internal forums to promote alignment and accountability across internal teams (e.g., SLA timelines, product performance and value, data monitoring / platform issues, etc.) + Serve as the main customer point of contact for key initiatives with a focus on solutioning, streamlining processes and working cross-functionally to ensure timely execution + Coordinate customer communication (payer and provider) on key initiatives, projects, or issues/incidents that impact service delivery + Develop an "issue resolution" playbook, promoting consistent definitions of problem types and standardizing solutioning + Ensure SLA's are maintained via a central database, instilling best practices for monitoring and managing across the customer org + Monitor internal issue ticketing system / reporting to ensure key customer issues are being addressed in a timely manner **The Experience You'll Need (Required):** + 5+ years of experience in account management or client services role in digital health, healthcare, payer + Previous experience managing a team of direct reports + Strong track record of high client satisfaction, growth and retention + Strong verbal, written and presentation skills; ability to communicate clearly and influence internal and external stakeholders + Strong analytical skills; ability to understand data and present information accordingly + Experience working in a cross-functional capacity + Strong leadership and effective problem abilities; must be able to develop and grow relationships with executive leaders, and internal cross-functional teams 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $-. 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!
$108k-162k yearly est. 3d ago
Director, Strategic Accounts
Evolent 4.6
Evolent job in Boston, MA
**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:** **Director, Strategic Accounts** **Put your passion where it meets purpose!** Evolent attracts some of the brightest minds in health care. Surround yourself with talented, driven colleagues who share a passion for better health outcomes and a more connected care journey. We are hiring a **Director, Strategic Accounts** to join our Customer Team. This role is unique: you will work directly with one of Evolent's largest, growing health plan clients and lead account strategy and execution. You'll have direct oversight of sales pipeline and renewals. This position partners with a customer operations lead and as a dyad you'll oversee cross-functional business and operating teams managing key client priorities. This position is highly strategic, with a strong emphasis on **upsell/cross-sell opportunities by fostering relationships, solutioning and problem solving, and communicating value.** **Collaboration Opportunities** As a consultative leader, you will identify growth opportunities within health plan specialty management and Evolent. The Strategic Account Director will implement relationship best practices, deliver on strategic growth initiatives, and drive measurable value while increasing satisfaction across all levels of the partner organization. **What You'll Be Doing** + **Strategically manage** an assigned book of business to achieve objectives in relationship development, growth, retention, and customer success. + **Identify and pursue growth opportunities** through analysis, customer research and active listening. Manage deal cycle including pitch, scope development, pricing, contract negotiations and implementation readiness. + **Define and facilitate execution of multi-year account strategy** including strategic account planning, relationship mapping, competitive analysis, and issue resolution. + **Manage and optimize contracts and performance** , by effectively partnering with Customer Operations dyad partner and Business Line leaders-ensuring compliance with SLAs, maximizing savings through benefit analysis, and adhering to legal and regulatory requirements. + **Articulate Evolent's value proposition and performance** across products and services, establishing fluency in key value drivers and measurements and opportunities for improvement + **Cultivate trusted relationships** with key executives, including C-level stakeholders, and serve as a liaison between internal and external teams. + **Leverage data-driven insights** to run efficient meetings and work sessions with clients and subject matter experts. + **Develop best-in-class presentations** and narratives for senior stakeholder meetings. + **Serve as an ambassador** for partner culture within Evolent and act as the go-to expert on client priorities. **Preferred Experience** + Bachelor's degree or equivalent work experience. + 5+ years of broad-based health care experience, health plan, and/or specialty or value-based care experience preferred + Strong **consulting background** with expertise in strategy, business development, and value based arrangements. + Ability to find creative solutions in a dynamic, evolving environment. + Exceptional communication and influencing skills at all organizational levels, including C-suite. + High emotional intelligence and ability to connect with diverse stakeholders. + **Travel:** Up to 40% within the U.S. and U.S. territories. 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $-. 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!
$115k-200k yearly est. 11d ago
Field Medical Director, Radiology (Neurology)
Evolent 4.6
Evolent job in Boston, MA
**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 As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. **What You Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. + Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a resource to Initial Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + Participates in on-going training per inter-rater reliability process. **Qualifications:** + MD/DO/MBBS + Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred + Current, unrestricted clinical license in medicine or required specialty- + Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs + Active Board Certification by an accredited organization + Strong clinical, management, communication, and organizational skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $94-99/hr. 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!
$94-99 hourly 60d+ ago
Managing Director, Strategic Accounts (California)
Evolent 4.6
Evolent job in Boston, MA
**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:** **What you'll be doing:** The Managing Director, Strategic Accounts role is a dynamic, fast paced position, serving as the single executive accountable for client health, strategy, success, and growth. This role provides the opportunity to own a book of client specific P&Ls including retention, expansion, and operational efficiency. It is a player coach role providing the opportunity to foster executive relationships at client accounts and lead a team of account directors and managers. **Who You'll Be Working With:** The Managing Director, Strategic Accounts embodies the Evolent value "Start by Listening," forging deep relationships and serving as a trusted C-suite advisor to Evolent's partners. This role also work in a highly cross-functiona capacity, including with key leaders and team members in our Operations and Provider Solutions teams. We are looking for a candidate with a strong entrepreneurial spirit to oversee strategic partnerships with a pool of large, multi-state and/or multi-line of business health plans. This role will report to Evolent's Chief Customer Officer **The Day-to-Day** + Serving as a strategic advisor and consultative partner, helping to identify opportunities for more impactful management of health plan's specialty care initiatives.; Managing the commercial process for these growth opportunities in collaboration with Business Development, Corporate Development and Operations leaders + Developing and orchestrating market-specific and enterprise performance initiatives; flagging risks for risk partner performance relative to financial goals + Managing a team of high-performing account leads, ensuring consistent market/client governance and appropriate allocation of team resources. + Taking responsibility for the satisfaction, retention, and growth of a portfolio of Evolent solutions across this account. Cultivating productive, trusted relationships with key partner executives and stakeholders + Owning the strategy and execution of the commercial process for contract management, negotiation, and renewals. Running regular Account Strategy Planning efforts, including relationship mapping, issue identification, and action planning + Proactively assessing, validating, and prioritizing partner needs on an ongoing basis, channeling input from partners into Evolent's product roadmap and strategy + With Operations and Provider Solutions teams, monitoring issue resolution and ensuring appropriate, timely follow up by Evolent team members; advocating on behalf of partner within Evolent to overcome challenges to partner value and ensuring Evolent addresses root causes of satisfaction issues + Advocating for partner culture, serving as an ambassador within Evolent and acting as the subject-matter-expert on partner priorities and getting things done within the partner organization **Qualifications:** + 10+ years in relationship management roles (consulting, enterprise sales, account management, etc.) + Bachelor's degree OR equivalent work experience. + Commercial / business development acumen to identify and close growth opportunities + Demonstrated ability to effectively communicate and present at all levels of the organization, including at the C-level. Influence through effective stories to emphasize the value proposition of the partnership. + Strong command of the financial elements of value-based care businesses and an ability to package this analysis into a compelling value proposition for specific growth opportunities and the partnership overall + A tenacious partnership ethos with a relentless focus on follow through and maintaining trust + The intellectual curiosity to get to the bottom of partner issues and opportunities and the willingness to roll up sleeves and work toward solutions in partnership with operations counterparts and centralized resources + Ability to manage heavy travel schedule, including ~3 days a week in-market at our partner organizations 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. 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** ************************** **for further assistance.** The expected base salary/wage range for this position is $160,000-180,000. 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!
$160k-180k yearly 4d ago

Evolent Health jobs in Providence, RI - 66 jobs

Director, Client Value

Director, Strategic Accounts

Clinical Reviewer, Occupational Therapy

Analyst, Application Support

Clinical Reviewer, Nurse Practitioner/Physician Assistant (Vascular Surgery)

Software Engineer

Clinical Reviewer, Nurse (Medical Oncology)

Director, Service Excellence

Field Medical Director, Cardiology

Clinical Reviewer, Occupational Therapy

Analyst, Application Support

Clinical Reviewer, Nurse Practitioner/Physician Assistant (Vascular Surgery)

Director, Client Value

Software Engineer

Managing Director, Strategic Accounts (California)

Field Medical Director, Oncology

Director, Service Excellence

Director, Strategic Accounts

Field Medical Director, Radiology (Neurology)

Managing Director, Strategic Accounts (California)

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