[Hiring] Coordinator, Intake Utilization Management @Evolent

Role Description

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.

SCHEDULE: 9:30 am - 6 pm Pacific; with rotating weekends and holidays

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:

• Medical reviews: LVNs, LPNs, and RNs
• Behavioral health reviewers: LMSWs, LCSW, and LPCs
• Clinical Reviewers

Opportunities to work collaboratively with other Utilization Management Leaders including our Associate Director and 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 to generate 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 displaying persistence in obtaining necessary information to address issues and problems.
• Meeting established Utilization Management Intake Objectives and Key Results.

Qualifications

• A high school diploma or GED - Required
• 1 – 3 years of experience in a Coordinator role either requesting or submitting prior authorization requests, or relevant health care experience in claims or appeal & grievance - Required
• Previous background/experience with Oncology - Preferred
• Ability to read, write, and speak the English language fluently with patients and providers - Required
• Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors - Required
• Proficient in using computer and Windows PC applications, which includes strong keyboard and navigation skills - Required
• Team-oriented, demonstrates a strong work ethic and is committed to productivity - Required
• Demonstrated ability to meet established goals while balancing a workload and prioritizing assignments in a remote environment - Required

Requirements

• 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

• High speed internet over 10 Mbps
• For all call center employees, the ability to plug in directly to the home internet router

Benefits

• The expected base salary/wage range for this position is $20.00.
• 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.