Job Description
Role Description
The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Oncology is responsible for support and assistance for all Oncology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer.
- Essential Duties and Responsibilities:
- Conducts initial clinical review of incoming cases, rendering authorization approval based on established clinical criteria or escalating to a Field Medical Director if authorization cannot be approved during initial review.
- Responsible for acting as a clinical liaison to providers, clients, and patients as directed by the office of the Chief Medical Officer.
- Responsible for clinical conversations with providers and their office staff regarding medical necessity decisions.
- Responsible for maintaining and operating the Guideline Directed Treatment plans including communicating with offices regarding treatment recommendations.
- Responsible for communicating need for additional clinical information to ordering providers.
- Responsibility for prepping cases which cannot be approved and which the provider will not modify or withdraw for P2P discussions with one of the Oncologists.
- Responsible for coordinating with UM staff to ensure timely and accurate communication of clinical decisions.
- Responsible for completion of UM projects and participation in site visit reviews.
- Respect and maintain HIPAA confidentiality guidelines.
- Responsible for maintaining availability to clinical and non-clinical administrative staff during performance of initial and second level screening.
- Acts as an interdepartmental liaison between all offices, departments, and committees.
- Serve as subject matter expert and participate in meetings as assigned with practices and/or payers.
- Will work with the Director of Clinical Operations to ensure client satisfaction.
- Perform all peer clinical review activities while located in a state or territory of the United States.
- Acts with honor and integrity, serving as a role model for the company.
- Performs other duties as assigned.
- Qualifications
- Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized degree program OR a masterโs degree from a program accredited by the ARC-PA.
- Minimum of three (3) to five (5) yearsโ experience in the practice of Oncology (required).
- Knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred).
- Requirements
- Current, unrestricted state PA or RN/NP license in medicine or required specialty.
- If a PA, obtaining a passing score on a national certifying exam.
- Obtaining and maintaining required licenses, per business need.
- A clinical license, active and in good standing, in your home state is required.
- Other Skills and Abilities
- Strong clinical, management, communication, and organizational skills.
- Demonstrated leadership skills.
- Analytic skills.
- Energetic and curious with a passion for quality and value in health care.
- Required to pass skills proficiency test.
- Technical Requirements
- High speed internet over 10 Mbps.
- Ability to plug in directly to the home internet router (specifically for all call center employees).
- Benefits
- The expected base salary/wage range for this position is $68-$73/hr.
- This position is also eligible for a bonus component that would be dependent on pre-defined performance factors.
- Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees.
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