Sr Analyst, Scope Management

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:

Senior Scope Analyst, Scope Management

The Specialty Scope Management team is made up of analysts, coders, and informatics professionals who work with national health plans to ensure that prior authorization and financial coding stay accurate, compliant, and aligned with evolving needs. As a member of our team, you’ll collaborate across disciplines, contribute to scalable solutions, and help shape data that drives care decisions.

We value curiosity to explore better ways of working, candor to communicate openly, and humility to learn from one another. We foster an inclusive environment where everyone’s voice matters—and we show up ready to own the opportunity to make healthcare better.

Collaboration Opportunities:  

The Senior Scope Analyst, Scope Management plays a crucial role in supporting the comprehensive management of prior authorization and financial scope within Evolent Specialty Services. Reporting to the Director, Clinical Informatics, this role is responsible for acquiring, synthesizing, and analyzing data from multiple sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through collaboration across the clinical, operations, product and technical teams.

What You Will Be Doing:

This position requires strong analytical skills, healthcare coding expertise, and a proactive approach to identifying trends, resolving discrepancies, and providing actionable insights. The ideal candidate will be adept at leveraging technology to enhance scope management processes while collaborating with internal stakeholders to ensure efficient and data-driven decision-making.

• Develop and implement streamlined processes to effectively manage scope-related inquiries from both client-facing and internal teams.

• Utilize technology-driven solutions to analyze trends, identify data shifts, and translate insights into actionable strategies.

• Provide analytical support and generate reports for client implementations, ad hoc projects, and coding maintenance updates.

• Apply expertise in healthcare coding to support prior authorization and financial scope reconciliations, ensuring accuracy and compliance.

• Conduct ongoing surveillance of coding updates from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), and various prior authorization lists, facilitating timely decision-making for clinical and business review teams.

• Demonstrate strong analytical abilities, with a proven track record of deriving valuable insights from both quantitative and qualitative data.

• Collaborate with internal teams to define, measure, and report key performance metrics related to clinical services.

• Identify data discrepancies and reporting gaps, working cross-functionally to improve data integrity and reporting outputs.

• Design and create data visualizations to present key insights to non-technical stakeholders in a clear and impactful manner.

• Perform other duties related to the management of prior authorization and financial scope, adapting to evolving business needs.

Qualifications - Required:

• Bachelor’s degree or qualitative major in a relevant field, such as healthcare administration, epidemiology, public health, biology, healthcare informatics, or nursing informatics.

• Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care, or healthcare consulting environment.

• Strong understanding of HCPCS, CPT, and ICD-10 coding systems.

• 5+ years of experience managing and analyzing large data sets, ensuring accuracy and usability.