Evolent Health jobs in Raleigh, NC - 22 jobs

**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!

The Community Health Worker (CHW) position is a non-clinician role that works with the primary care health team as a multi-disciplinary team member as a link/liaison between the community and the primary care practices also known at Advance Medical Homes (AMH). CHWs will be intentional on carrying out community in-reach- bringing the community voice into the clinical setting. CHWs are trusted community members that share similarities with the community members they serve. The CHW will focus on improving access to AMHs by providing culturally appropriate health education, navigating social services, facilitating communication, providing direct services (health screenings, basic first aid, mental health first aid, informal counseling, translation and interpretation services), and advocating for the needs of the Medicaid population. Community Health Workers may directly assist members in improving their ability to improve their health by going to members in their communities and meeting them physically, mentally and socially. They also help design and implement systems to ensure members have access, knowledge, resources, and support from the Care Team. Essential Functions Abide by CCNC Care Management department guidelines, CCNC company policies, and HIPAA regulations. Adhere to CCNC Privacy and Security policies to ensure that patient and company data is properly safeguarded. Understand and uphold CCNC Mission, Vision, and Values. Successfully complete and be able to demonstrate the CHW Core Competency Skills to include: Communication Interpersonal Service Capacity Building Advocacy Education Outreach Knowledge Personal Participate in community population-based initiatives that identify members out of care, enhance retention in care, empower self-management, and compliance with CCNC Care Management goals. Participate and/or initiate community-based activities, including outreach to targeted populations to include selected chronic conditions, potential new members, and make referrals for healthcare and services. Receive and document all referrals from various sources into the Care Management documentation platform. Verify Medicaid eligibility and demographic information. Provide information for access and coordination of resources. Assist member with care coordination and health care system navigation. Advocate for members. Access and document in multiple EHR's to include Hospitals, AMH EHRs and CCNC care management platform. Notify supervisor promptly of any issues with carrying out any duties assigned. Attend departmental and corporate meetings, local and regional training, or other events as required. Travel using personal vehicle will be required within the region and/or the state. Perform other duties that assist in keeping the operations organized and functional. Qualifications High school diploma or GED required 2-year or 4-year degree in health-related field preferred CHW Certification preferred (not required but must be obtained within 1 year after successful completion of orientation) 2-4 years minimum experience in a human services or health care setting with demonstrated knowledge of or ability work and/or within a targeted community Bilingual in English and Spanish preferred Maintain a U.S. valid driver's license with current auto liability insurance Knowledge, Skills, and Abilities Knowledge of and experience working in patient or clinical data systems Knowledge of geographical community resources that you are applying for Knowledge of state and federal benefits system Knowledge of medical terminology Computer skills required including various office software and the internet; experience with MS Office software preferred Ability to apply motivational interviewing skills in your communication Excellent communication skills - oral and written Proficient motivational interviewing skills, teach back method, and other patient engagement and retention techniques Organizational and time management skills Sensitivity to diversity of cultures, language barriers, health literacy and educational levels Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives Ability to shift strategy or approach in response to the demands of a situation Working Conditions The job environment is a hybrid-environment to include community settings, AMH practices, and home environment. Multiple contacts are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time, lifting products >10 lbs., and standing long periods of time while at community events Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds Travel will be required within the region and/or the State

**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 SaaS Administrator is responsible for managing the full lifecycle of SaaS applications across the organization. This includes discovering, optimizing, securing, and governing SaaS usage to maximize business value and ensure compliance. This role also supports administration functions of enterprise platforms including Jira, Confluence, Jira CMDB, Statuspage. **Key Responsibilities:** + Manage the SaaS life cycle: discover SaaS usage, manage SaaS configuration policies, optimize SaaS entitlements, automate SaaS-related employee onboarding and offboarding processes, measure and publish reports on SaaS usage and costs for IT leadership + Collaborate with digital workplace engineering & security teams to establish and document SaaS configuration, security controls, compliance requirements and processes to continually identify vulnerabilities in configuration and noncompliant usage of SaaS apps + Administer and optimize Atlassian platforms (Jira, Confluence, Statuspage, Jira CMDB, JSM Operations, Atlassian Analytics), including migrations, workflow analysis, automation, and integration of third-party apps + Integrate SaaS and enterprise platforms to enable and streamline IT processes (e.g., ITSM, IAM, ITAM) and business workflows, facilitating tool adoption by understanding stakeholder requirements, managing implementations, and conducting testing and User Acceptance Testing (UAT) + Produce usage reports and perform system health checks + Engage with vendors' support teams to resolve platform issues + Create and communicate knowledgebase articles to support IT staff and minimize support overhead + Ensure that the needs of all customers are met accurately and in a timely fashion, as documented in team Service Level Agreements (SLAs) + Continue to improve technical expertise through research and identification of new processes and technical alternatives to resolve problems and/or implement continuous improvement + Adhere to and advocate all requirements of IT Privacy and Security Policies and Procedures + Participate and contribute to project and team meetings. Transfer knowledge, share expertise, and continuously mentor and collaborate with other members of the team **Required Qualifications:** + Bachelor's degree in IT or related field + 3+ years of experience in IT operations, SaaS administration, and supporting datacenter and cloud-based Atlassian applications (Jira, Confluence, Crowd) + Strong analytical, problem-solving, collaboration, and documentation skills + Familiarity with ITSM, IAM, CMDB systems + Experience working with audit, privacy, and security requirements, including SOC2, and HIPAA + Ability to work in a dynamic environment, including the ability to manage and prioritize tasks while maintaining a service-oriented work ethic + Must be very detail-oriented, organized and able to work independently to support multiple complex projects simultaneously in a fast-paced environment + Experience with automation/scripting tools (e.g., PowerShell, Bash, Python) is preferred + Ability to learn new technologies and explain technical issues to diverse audiences is preferred + Relevant certifications, such as ITIL Foundation Certification and Atlassian cloud certifications, are 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 $88,000 - 105,000. 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!

**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** We are seeking a technically strong Implementation Engineer with expertise in data integration to support the full lifecycle of client onboarding and data pipeline development. This role involves configuring systems, resolving implementation issues, and building scalable data workflows using SQL, SSIS, ADF, and Python. **Responsibilities:** + Support the full implementation lifecycle: development, testing, deployment, and go-live. + Troubleshoot and resolve technical issues during implementation to ensure smooth transitions. + Design, build, and maintain data pipelines and ETL workflows using SQL, SSIS, ADF, and Python. + Interpret and implement data models and mappings for integration tasks. + Collaborate with cross-functional teams to translate business requirements into technical solutions. + Monitor and optimize data quality, performance, and reliability. + Maintain technical documentation and provide post-implementation support. **Requirements:** + Bachelor's degree in Computer Science, Software Engineering, IT, or related field. + 5+ years of experience in software implementation, system integration, or data engineering. + Strong proficiency in SQL, SSIS or relevant tool, experience with Azure Data Factory is a plus. + Solid understanding of data models, data mappings, and relational databases. + Familiarity with APIs and cloud platforms (e.g., Azure). + Excellent communication skills with the ability to explain technical concepts to diverse audiences. + Self-driven, detail-oriented, and capable of working independently or in a team environment. 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 $90,000 - 110,000. 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!

**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!

**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 member of the Platform Engineering organization, you will be part of a team responsible for managing the large footprint of our application suite and cloud infrastructure. We are transforming the way we manage cloud infrastructure and application reliability, your role as a Platform Engineer with a **sharp focus on observability** is instrumental in our success. This role is for you If you are interested in becoming part of our high-performance team. **Responsibilities** : + Engineer and manage observability solutions using **OpenTelemetry** to monitor and trace application performance. + Contribute to Evolent's Internal Developer Platform built on **Backstage** technology via hands on code writing. + Deploy and manage containerization solutions using platforms such as **Docker** and **Kubernetes** , with a strong focus on **Azure Kubernetes Service (AKS)** and **Azure Container Apps (ACA)** . + Monitor the health and performance of containers and resolve any issues that arise. + Partner with DevOps in advancing **Infra as Code** and **Config as Code** discipline. + Participate in Root Cause Analysis (RCA) and actually address root cause to prevent future occurrence of same problem. + Follow security best practice to ensure containerized workloads are fully secure. **Required Experience:** + 3+ years of hands-on **Azure** and 5+ years of overall cloud-native experience. + Demonstrated motivation to develop coding skills and proficiency in multiple programming languages. + Strong understanding of **OpenTelemetry** and experience in implementing observability solutions. + Expertise in multiple APM tools: Prometheus, **Elastic** , Dynatrace, **DataDog** . + Proficient in **TypeScript** and **React** for building internal platform UIs or developer portal. + Proven experience in deploying and managing container orchestration platforms such as **Kubernetes** and **Docker** . + Deep understanding of deployment methodologies for Kubernetes, preferably **ArgoCD** and **Helm** . + Experience with other Azure services such as **Azure Functions, Azure Logic Apps,** and **Azure Service Fabric** . + Passion and creativity for Automation using tools such as **Ansible** and **Terraform** . + Experience in working with **GitHub Actions** or Jenkins. + Expertise in at least one of these **scripting/configuration** languages: PowerShell, YAML, HCL, Python. + Experience leveraging **agile** methodology (i.e., Scrumban) to manage project work. + Highly **effective communicator** with a strong commitment to transparency. 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 - 135,000. 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!

**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 **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization Management. In support of our daily operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required. + Entering data into a proprietary system generating cases for both the medical and behavioral health reviewers. These requests may be submitted via fax, email, or provider portal. + Working directly with physician's offices to obtain missing information required to submit a prior authorization request. + Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion. + Addressing requests promptly and courteously, honoring commitments and displays persistence obtaining necessary information to address issues and problems. + Meeting established Utilization Management Intake Objective and Key Results. **What You Bring:** + A high school diploma or GED is required. + 1 - 3 years of experience in a Coordinator role either requesting or submitting prior authorization requests and/or relevant health care experience in claims or appeal & grievances is required. + Ability to read, write and speak the English language fluently with patients and providers. + Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors. + Proficient using computer and Windows PC applications, which includes strong keyboard and navigation skills. + Team oriented, demonstrates a strong work ethic and committed to productivity. + Ability to sit for the majority of shift. + Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment. 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 $20.00/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!

We're hiring Care Manager 1 - Non Clinical across all 100 NC Counties - Must reside in NC or within 40 miles of NC border. Must reside in the following NC counties : Alamance, Ashe, Avery, Beaufort, Bertie, Brunswick, Buncombe, Burke, Cabarrus, Caldwell, Catawba, Chatham, Cleveland, Cumberland, Davidson, Davie, Durham, Forsyth, Gaston, Graham, Granville, Guilford, Haywood, Henderson, Iredell, Lincoln, McDowell, Mecklenburg, Mitchell, Nash, Orange, Pender, Randolph, Robeson, Rockingham, Rutherford, Sampson, Stanly, Stokes, Surry, Union, Wake, Wayne, Wilson, Yadkin, and more! This is a field-based position with working remotely, when not providing integrated services to members directly. Occasional in-person training and travel will be required. About CCNC: From the mountains to the coast, from large cities to small towns, Community Care of North Carolina is transforming health care. Informed by statewide data and predictive analytics, community-based care-managers work with local physicians and diverse teams of health professionals to develop whole-person plans of care that connect people to the right local resources and increase equity and access to high quality care. CCNC Mission Statement: To improve the health and quality of life for all North Carolinians by building supporting better community-based healthcare delivery systems. Position Summary Our new program, the Care Manager 1 - Non Clinical, will provide statewide care management to support Medicaid enrolled members receiving adoption assistance. Care Managers address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required so they receive seamless, integrated, and coordinated health care to promote quality, cost-effective health outcomes. Collaboration with the Primary Care Provider, member, guardian, caregivers, family members, other members of the Care Management Team, and the community is necessary to coordinate a full continuum of health care services. Holistic needs of the member, inclusive of unique social and cultural dynamics should be considered. The Care Manager must reside in NC or within 40 miles of the NC Border. What You'll Do: Provide integrated whole-person Care Management under the new program Care Management model, including coordination across physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs. Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care Work with members and caregivers to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness Utilize Hospital/Data or Electronic Medical Record system as available Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies Refer to appropriate clinical team members for interventions which are outside the Care Managers' scope of practice and/or expertise Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication Respect the member's values, experience, and help to empower members to be an advocate for their own care Maintain appropriate documentation in the Care Management documentation platform, in accordance with organizational policies and procedures Meet monthly productivity and role expectations Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded Perform all other duties as requested Attend departmental and corporate meetings, local and regional trainings, or other events as required Travel using personal vehicle will be required within the assigned area, region and/or the State Qualifications: Requires a Bachelor's Degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area or licensure as an RN 2 years of experience working directly with individuals served by the child welfare system is preferred Must reside in NC or within forty (40) miles of the NC Border CCM certification preferred Maintain a valid driver's license with current auto liability insurance Knowledge, Skills, and Abilities: Computer skills required including various office software and the internet; including experience with MS Office software. Excellent communication skills - oral and written; Bilingual preferred Knowledge of government, private sector, and community resources Knowledge of Case Management principles Knowledge of, and compliance with, federal and state regulations applicable to the position Strong organizational and time management skills Skills in establishing rapport with members and caregivers and applying techniques of assessing comprehensive health care needs Critical thinking skills, effective clinical judgment, independent decision-making, and problem-solving abilities Sensitivity to diversity of cultures, language barriers, health literacy, and educational levels Ability to work independently and function as an integral part of a multi-disciplinary team Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives Ability to shift strategy or approach in response to the demands of a situation Ability to navigate Hospital/Data or Electronic Medical Record systems, as necessary Working Conditions: This is a field position. Care Manager will work remotely from home when not in the field Multiple contacts, face to face and/or telephonic, are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds Travel will be required within the assigned area or region with occasional travel in other areas of the State Why Join Us: Make a meaningful impact on youth and families across North Carolina Work with a supportive and collaborative care team Competitive Benefits Package effective first day of employment Tuition reimbursement provided to foster CCNC's culture of learning and knowledge, personal and professional growth Ready to improve the health and quality of life of all North Carolinians by building and supporting better community-based health care delivery systems? Apply today and join us in delivering compassionate care that makes a difference. #CCNC #HealthCare #NCHealth

**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 Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures while complying with timeliness guidelines. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes for the Clients and Members we serve. **Collaboration Opportunities:** The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for collaboration include all-team and individual team meetings, Teams chats, and monthly communication on team metrics and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with other departments to satisfactorily resolve issues related to appeals and retrospective reviews. + Provides optimum customer service through professional and accurate communication while maintaining accreditation and health plan's required timeframes. + Refers cases to appropriate internal reviewers according to the business needs of the particular health plan. + Reviews requests for Urgent appeals compared to expedited criteria for downgrade to Standard processing, documenting accordingly. + Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals. + Other duties as assigned. **Qualifications Required and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality improvement environment- **Required** + Able to work in a rotation to work 10:30am to 7pm CST (which includes 30-minute unpaid lunch break) 3 days/week, to meet the business needs of nurses providing coverage until 7:00pm CST. - **Required** + Must be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate through internal and external computer systems. Working knowledge of Microsoft Office Product Suit - **Preferred** + Strong organizational and effective time management skills; demonstrated ability to manage multiple priorities. - **Preferred** + Outstanding interpersonal and negotiation skills to effectively establish positive relationships both internally and externally, including strong written and verbal communication skills. - **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 $37- $42/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!

**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:** Evolent is seeking an experienced Managing Director of Product Management to help Evolent grow by partnering with Payers to deliver solutions across multiple specialties, offering the potential to improve health outcomes and increase affordability. You will be a part of a cross-functional Evolent team that serves as a pivotal strategic partner to health systems and provider practice groups. **Key Responsibilities:** + Drive a Product-focused, Partner-First Implementation Strategy. + Work alongside Evolent's Partner Operations and Strategic Account Teams to create a standard implementation approach across partners and specialties that emphasizes "out-of-the-box" functionality. + Develop strategies for slotting opportunities well in advance of requirement gathering that maximizes both Partner satisfaction and team capacity for discovery and development. + Partner with Evolent Engineering to Streamline Implementations. + Where necessary, partner with Evolent Engineering to define, prioritize, and build and enhance technology that allows for efficient, scalable, and accurate onboarding of new business. + Serve as the voice of the customer to communicate Partner-specific configuration and non-standard requirements to deliver the highest quality integrations between Evolent and Partner. + Develop and Lead a High Performing Team. + Serve as a competent and engaging people-leader across Product Management and Product Owner resources supporting application configuration and client pipeline teams. **Required Qualifications:** + Bachelor's degree required. Master's degree in public health, Healthcare Administration, or a related field preferred. + At least eight years of healthcare technology Product Management experience, ideally in a services-oriented organization. + Strong demonstrated understanding of provider, and payer personas, 'jobs to be done' and practice workflows, with a preference for expertise in UM workflows + Exceptional verbal and written communication skills, with the ability to articulate complex concepts clearly to diverse audiences (clinicians, engineering, administrative staff, leadership). + Experience with scrum and agile methodologies. + Proven experience working closely with Payer customers is required. + Experience with Lean/Six Sigma or other process improvement methodologies in a healthcare setting is 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 $175,000 - 195,000. 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!

**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:** Evolent is seeking a Software Engineer to join an Agile team building healthcare‑focused backend software solutions that support analytics, integration, and operational workflows across the healthcare ecosystem. In this role, you will design and develop scalable backend services using Python and FastAPI, and build event‑driven and serverless solutions leveraging Microsoft Azure services such as Azure Functions and Azure Event Hub. You will also develop and maintain data ingestion pipelines that load healthcare data into Microsoft Fabric to support enterprise reporting and analytics needs. Team members contribute across the full software development lifecycle and are expected to wear multiple hats. You will participate in architecture and design discussions, author and review design documentation, and implement high‑quality, maintainable code. You will collaborate closely with product owners, QA partners, and fellow software engineers in an Agile environment, contributing to sprint planning, stand‑ups, retrospectives, and iterative delivery. As needed, you will assist with testing, debugging, and validation to ensure solutions meet quality, performance, and regulatory expectations. The role includes modernizing and optimizing existing systems, including performance tuning legacy SQL stored procedures to improve efficiency and scalability. You will use GitHub workflows to support CI/CD pipelines, code reviews, and automated quality checks, and write unit tests to improve code coverage and maintainability. The ideal candidate is comfortable working in a fast‑paced healthcare technology environment, brings strong backend engineering fundamentals, and actively leverages Copilot and other AI‑assisted tools to solve complex problems and improve developer productivity. **Responsibilities** + Design, develop, test, and maintain data-driven software applications using Python and modern frameworks. + Build and optimize API-based solutions leveraging Python (FastAPI, Django, Flask) for scalable integrations. + Develop and maintain data pipelines and ETL workflows using tools such as Azure Data Factory, Fabric, PySpark, and related technologies. + Write clean, maintainable, and efficient code following best practices and coding standards. + Collaborate with product managers, designers, and other engineers to translate requirements into technical specifications. + 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 continuous improvement of development processes, tools, and methodologies. + Stay up-to-date with emerging technologies and industry trends, applying them to improve our products and solutions. **Requirements** + Bachelor's degree in Computer Science, Software Engineering, or related field, or equivalent practical experience. + 3+ years of experience in software engineering or data engineering roles. + Strong proficiency in Python, including experience developing API-based solutions (FastAPI, Django, Flask). + Hands-on experience with Azure data services (Azure Data Factory, Fabric, Synapse) and ETL tools (SSIS or similar) with experience writing stored procedures. + Experience with PySpark, Databricks, or other Spark-based frameworks for large-scale data processing. + Solid understanding of SQL, T-SQL, and experience writing stored procedures in SQL Server or similar relational databases. + Solid understanding of data modeling, data pipelines, and data transformation best practices. + Experience with cloud platforms (Azure preferred; AWS or GCP is a plus). + Knowledge of containerization tools (Docker, Kubernetes) for deploying data solutions. + Familiarity with version control systems (Git) and collaborative coding workflows. + Ability to write unit and integration tests to ensure code quality and reliability. + Excellent problem-solving skills and ability to work independently and as part of a team. + Strong communication skills with the ability to articulate technical concepts to both technical and non-technical stakeholders. + Healthcare experience (especially in authorization/prior-authorization workflows) is a strong plus. 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 $100,000 - 120,000. 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!

The Community Health Worker (CHW) position is a non-clinician role that works with the primary care health team as a multi-disciplinary team member as a link/liaison between the community and the primary care practices also known at Advance Medical Homes (AMH). CHWs will be intentional on carrying out community in-reach- bringing the community voice into the clinical setting. CHWs are trusted community members that share similarities with the community members they serve. The CHW will focus on improving access to AMHs by providing culturally appropriate health education, navigating social services, facilitating communication, providing direct services (health screenings, basic first aid, mental health first aid, informal counseling, translation and interpretation services), and advocating for the needs of the Medicaid population. Community Health Workers may directly assist members in improving their ability to improve their health by going to members in their communities and meeting them physically, mentally and socially. They also help design and implement systems to ensure members have access, knowledge, resources, and support from the Care Team. Essential Functions Abide by CCNC Care Management department guidelines, CCNC company policies, and HIPAA regulations. Adhere to CCNC Privacy and Security policies to ensure that patient and company data is properly safeguarded. Understand and uphold CCNC Mission, Vision, and Values. Successfully complete and be able to demonstrate the CHW Core Competency Skills to include: Communication Interpersonal Service Capacity Building Advocacy Education Outreach Knowledge Personal Participate in community population-based initiatives that identify members out of care, enhance retention in care, empower self-management, and compliance with CCNC Care Management goals. Participate and/or initiate community-based activities, including outreach to targeted populations to include selected chronic conditions, potential new members, and make referrals for healthcare and services. Receive and document all referrals from various sources into the Care Management documentation platform. Verify Medicaid eligibility and demographic information. Provide information for access and coordination of resources. Assist member with care coordination and health care system navigation. Advocate for members. Access and document in multiple EHR's to include Hospitals, AMH EHRs and CCNC care management platform. Notify supervisor promptly of any issues with carrying out any duties assigned. Attend departmental and corporate meetings, local and regional training, or other events as required. Travel using personal vehicle will be required within the region and/or the state. Perform other duties that assist in keeping the operations organized and functional. Qualifications High school diploma or GED required 2-year or 4-year degree in health-related field preferred CHW Certification preferred (not required but must be obtained within 1 year after successful completion of orientation) 2-4 years minimum experience in a human services or health care setting with demonstrated knowledge of or ability work and/or within a targeted community Bilingual in English and Spanish preferred Maintain a U.S. valid driver's license with current auto liability insurance Knowledge, Skills, and Abilities Knowledge of and experience working in patient or clinical data systems Knowledge of geographical community resources that you are applying for Knowledge of state and federal benefits system Knowledge of medical terminology Computer skills required including various office software and the internet; experience with MS Office software preferred Ability to apply motivational interviewing skills in your communication Excellent communication skills - oral and written Proficient motivational interviewing skills, teach back method, and other patient engagement and retention techniques Organizational and time management skills Sensitivity to diversity of cultures, language barriers, health literacy and educational levels Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives Ability to shift strategy or approach in response to the demands of a situation Working Conditions The job environment is a hybrid-environment to include community settings, AMH practices, and home environment. Multiple contacts are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time, lifting products >10 lbs., and standing long periods of time while at community events Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds Travel will be required within the region and/or the State

Job DescriptionWe're hiring Care Manager 1 - Non Clinical across all 100 NC Counties - Must reside in NC or within 40 miles of NC border. Must reside in the following NC counties : Alamance, Ashe, Avery, Beaufort, Bertie, Brunswick, Buncombe, Burke, Cabarrus, Caldwell, Catawba, Chatham, Cleveland, Cumberland, Davidson, Davie, Durham, Forsyth, Gaston, Graham, Granville, Guilford, Haywood, Henderson, Iredell, Lincoln, McDowell, Mecklenburg, Mitchell, Nash, Orange, Pender, Randolph, Robeson, Rockingham, Rutherford, Sampson, Stanly, Stokes, Surry, Union, Wake, Wayne, Wilson, Yadkin, and more! This is a field-based position with working remotely, when not providing integrated services to members directly. Occasional in-person training and travel will be required. About CCNC: From the mountains to the coast, from large cities to small towns, Community Care of North Carolina is transforming health care. Informed by statewide data and predictive analytics, community-based care-managers work with local physicians and diverse teams of health professionals to develop whole-person plans of care that connect people to the right local resources and increase equity and access to high quality care. CCNC Mission Statement: To improve the health and quality of life for all North Carolinians by building supporting better community-based healthcare delivery systems. Position Summary Our new program, the Care Manager 1 - Non Clinical, will provide statewide care management to support Medicaid enrolled members receiving adoption assistance. Care Managers address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required so they receive seamless, integrated, and coordinated health care to promote quality, cost-effective health outcomes. Collaboration with the Primary Care Provider, member, guardian, caregivers, family members, other members of the Care Management Team, and the community is necessary to coordinate a full continuum of health care services. Holistic needs of the member, inclusive of unique social and cultural dynamics should be considered. The Care Manager must reside in NC or within 40 miles of the NC Border. What You'll Do: Provide integrated whole-person Care Management under the new program Care Management model, including coordination across physical health, behavioral health, I/DD, LTSS, pharmacy, and unmet health-related needs. Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care Work with members and caregivers to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness Utilize Hospital/Data or Electronic Medical Record system as available Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies Refer to appropriate clinical team members for interventions which are outside the Care Managers' scope of practice and/or expertise Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication Respect the member's values, experience, and help to empower members to be an advocate for their own care Maintain appropriate documentation in the Care Management documentation platform, in accordance with organizational policies and procedures Meet monthly productivity and role expectations Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded Perform all other duties as requested Attend departmental and corporate meetings, local and regional trainings, or other events as required Travel using personal vehicle will be required within the assigned area, region and/or the State Qualifications: Requires a Bachelor's Degree in a field related to health, psychology, sociology, social work, nursing, or another relevant human services area or licensure as an RN 2 years of experience working directly with individuals served by the child welfare system is preferred Must reside in NC or within forty (40) miles of the NC Border CCM certification preferred Maintain a valid driver's license with current auto liability insurance Knowledge, Skills, and Abilities: Computer skills required including various office software and the internet; including experience with MS Office software. Excellent communication skills - oral and written; Bilingual preferred Knowledge of government, private sector, and community resources Knowledge of Case Management principles Knowledge of, and compliance with, federal and state regulations applicable to the position Strong organizational and time management skills Skills in establishing rapport with members and caregivers and applying techniques of assessing comprehensive health care needs Critical thinking skills, effective clinical judgment, independent decision-making, and problem-solving abilities Sensitivity to diversity of cultures, language barriers, health literacy, and educational levels Ability to work independently and function as an integral part of a multi-disciplinary team Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives Ability to shift strategy or approach in response to the demands of a situation Ability to navigate Hospital/Data or Electronic Medical Record systems, as necessary Working Conditions: This is a field position. Care Manager will work remotely from home when not in the field Multiple contacts, face to face and/or telephonic, are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds Travel will be required within the assigned area or region with occasional travel in other areas of the State Why Join Us: Make a meaningful impact on youth and families across North Carolina Work with a supportive and collaborative care team Competitive Benefits Package effective first day of employment Tuition reimbursement provided to foster CCNC's culture of learning and knowledge, personal and professional growth Ready to improve the health and quality of life of all North Carolinians by building and supporting better community-based health care delivery systems? Apply today and join us in delivering compassionate care that makes a difference. #CCNC #HealthCare #NCHealth

**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!

**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:** **Lead the Transformation in Oncology Care** At Evolent, we're redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal role in advancing value-based care models that prioritize clinical excellence, patient-centered outcomes, and system-wide impact. This role offers the opportunity to collaborate with top-tier clinicians, influence care pathways, and drive innovation in one of the most critical areas of health care. If you're passionate about making a measurable difference in oncology, this is your platform to lead with purpose. In this role, you will combine your clinical oncology expertise with a focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician reviewer for oncology cases that do not initially meet medical necessity criteria, applying evidence-based guidelines to ensure high-quality and cost-effective care. + Conduct peer-to-peer discussions with requesting oncologists-not only to explain determinations but to **partner in driving practice patterns aligned with value and quality outcomes** . + Support clinical reviewers as a subject matter expert and resource. + **Practice & Physician Engagement** + Actively participate in **engagement sessions with oncology practices** , sharing best clinical practices and supporting broader adoption of evidence-based pathways. + Foster trusted peer relationships with oncologists to encourage **sustainable behavior change** that improves patient outcomes. + Support practice-level transformation initiatives that reduce unwarranted variation and enhance quality. + **Internal Strategy & Value Initiatives** + Collaborate with Evolent's clinical leadership on the **design, build, and execution of new value initiatives in oncology** . + Provide input on innovation opportunities, clinical algorithms, and models of care that support transformation in specialty care. + Partner with operational and analytic teams to assess the impact of interventions and identify opportunities for continuous improvement. + Participate in audit processes to validate accuracy of advance payment model payouts, ensuring alignment with clinical documentation, performance metrics, and contractual expectations. + **Compliance & Quality** + Ensure all reviews and engagements align with URAC, NCQA, and internal quality standards. + Document peer interactions and clinical decisions in a timely and accurate manner. + Participate in training and inter-rater reliability processes. **Qualifications** + MD/DO/MBBS with board certification in **Medical Oncology** . + Minimum five (5) years' post-residency experience, with active clinical practice preferred within the past 2 years. + Current, unrestricted medical license (multiple state licenses preferred or willingness to obtain). + Demonstrated **leadership in practice transformation, value-based care, or clinical quality improvement** . + Strong communication, collaboration, and organizational skills, with proven ability to influence physician behavior. + Energetic, curious, and passionate about **shaping the future of oncology care delivery** . + Not under sanction or exclusion from Medicare/Medicaid programs. 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 $120-130/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!

Job Description The Community Health Worker (CHW) position is a non-clinician role that works with the primary care health team as a multi-disciplinary team member as a link/liaison between the community and the primary care practices also known at Advance Medical Homes (AMH). CHWs will be intentional on carrying out community in-reach- bringing the community voice into the clinical setting. CHWs are trusted community members that share similarities with the community members they serve. The CHW will focus on improving access to AMHs by providing culturally appropriate health education, navigating social services, facilitating communication, providing direct services (health screenings, basic first aid, mental health first aid, informal counseling, translation and interpretation services), and advocating for the needs of the Medicaid population. Community Health Workers may directly assist members in improving their ability to improve their health by going to members in their communities and meeting them physically, mentally and socially. They also help design and implement systems to ensure members have access, knowledge, resources, and support from the Care Team. Essential Functions Abide by CCNC Care Management department guidelines, CCNC company policies, and HIPAA regulations. Adhere to CCNC Privacy and Security policies to ensure that patient and company data is properly safeguarded. Understand and uphold CCNC Mission, Vision, and Values. Successfully complete and be able to demonstrate the CHW Core Competency Skills to include: Communication Interpersonal Service Capacity Building Advocacy Education Outreach Knowledge Personal Participate in community population-based initiatives that identify members out of care, enhance retention in care, empower self-management, and compliance with CCNC Care Management goals. Participate and/or initiate community-based activities, including outreach to targeted populations to include selected chronic conditions, potential new members, and make referrals for healthcare and services. Receive and document all referrals from various sources into the Care Management documentation platform. Verify Medicaid eligibility and demographic information. Provide information for access and coordination of resources. Assist member with care coordination and health care system navigation. Advocate for members. Access and document in multiple EHR's to include Hospitals, AMH EHRs and CCNC care management platform. Notify supervisor promptly of any issues with carrying out any duties assigned. Attend departmental and corporate meetings, local and regional training, or other events as required. Travel using personal vehicle will be required within the region and/or the state. Perform other duties that assist in keeping the operations organized and functional. Qualifications High school diploma or GED required 2-year or 4-year degree in health-related field preferred CHW Certification preferred (not required but must be obtained within 1 year after successful completion of orientation) 2-4 years minimum experience in a human services or health care setting with demonstrated knowledge of or ability work and/or within a targeted community Bilingual in English and Spanish preferred Maintain a U.S. valid driver's license with current auto liability insurance Knowledge, Skills, and Abilities Knowledge of and experience working in patient or clinical data systems Knowledge of geographical community resources that you are applying for Knowledge of state and federal benefits system Knowledge of medical terminology Computer skills required including various office software and the internet; experience with MS Office software preferred Ability to apply motivational interviewing skills in your communication Excellent communication skills - oral and written Proficient motivational interviewing skills, teach back method, and other patient engagement and retention techniques Organizational and time management skills Sensitivity to diversity of cultures, language barriers, health literacy and educational levels Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives Ability to shift strategy or approach in response to the demands of a situation Working Conditions The job environment is a hybrid-environment to include community settings, AMH practices, and home environment. Multiple contacts are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time, lifting products >10 lbs., and standing long periods of time while at community events Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds Travel will be required within the region and/or the State

**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!

**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 Physician Clinical Reviewer, Interventional Pain Management, 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. Aids and acts as a resource to Initial Clinical Reviewers. **What You Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing 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. + 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. + Provides clinical rationale for standard and expedited appeals. + 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. + 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. May assist the Senior Medical Director in research activities/questions. **Qualifications - Required and Preferred:** + MD/DO/MBBS- **Required** + Minimum of five (5) years' experience in the practice of Pain Medicine, post-residency- **Preferred** + Current, unrestricted clinical license in medicine or required specialty- **Required** + Obtaining and maintaining medical licenses in the state you reside and any required per business needs- **Required** + Active Board Certification in Pain Management or Active Board Certification in another specialty and clinical experience in Interventional Pain Management- **Required** + Strong clinical, management, communication, and organizational skills- **Required** + Energetic and curious with a passion for quality and value in health care- **Required** + Computer Proficiency- **Required** 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 $105-110/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!

**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 $95-110/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!