UR Nurse

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:

To ensure the appropriate utilization of services act as an advocate for our members and to ensure the highest quality and cost-effective care.

Collaboration Opportunities:

As a UR Nurse in the Utilization Management department, you will work closely with other nurses, managers, medical directors, and upper leadership as requested.

What You Will Be Doing:

• Reviews Provider requests for relevant and complete supporting documentation and requests for missing or additional documentation from providers per guidelines.

• Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN has the authority to authorize services or procedures. If a request does not meet established clinical guidelines for appropriateness and medical necessity, the request is sent to a physician reviewer. At no time can a URN recommend an adverse determination.

• Verifies the accuracy of codes and services and applies them accurately with appropriate documentation.

• Complies with current URAC standards as they relate to this position and ensures regulatory guidelines are met for timeliness and use of medical review criteria.

• Supports clinical initiatives as identified by the UM department and UMC and acts as an interdepartmental liaison between all Evolent departments.

• Acts with honor and integrity, serving as a role model for the company while establishing and maintaining professional relationships with Providers and office staff.

• Complies with HIPAA requirements and all Evolent policies and procedures.

• Performs other duties as assigned including but not limited to developing report data elements necessary to track and trend utilization practices by provider, practice variation reports, reports to support quality initiatives, and elements to support Evolent dashboard reports.

Qualifications Required and Preferred:

• An unrestricted Registered Nurse (RN), LPN or LVN license is required for the state of employment. - Required

• Oncology/Cardiology/ Radiation Oncology or Surgical Oncology experience Strongly - Preferred

• Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel. - Required

• Able to work in a fast-paced environment, demonstrate excellent problem-solving, critical thinking, and organizational skills Perform multiple tasks efficiently and accurately, have exceptional attention to detail and perform consistent work product validation/QA. - Required

• Strong computer skills in Microsoft Office programs as well as EMR, Sharepoint, and website navigation and email organization. - Required

• 2 - 4 years of UM experience - Preferred

• 2 - 3 years in an inpatient or outpatient setting highly - Preferred

• Specialty certification - Preferred

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 recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $34 - 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 com