Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Clinical Letter Writer, UM RN

Expired Job

Evolent Health, Inc. Austin , TX 78719

Posted 6 months ago

Nurse Reviewer (RN) Clinical Letter Writer

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of "Becker's 150 Great Places to Work in Healthcare" in 2016 and 2017, and one of the "50 Great Places to Work" in 2017 by Washingtonian, and our CEO was number one on Glassdoor's 2015 Highest-Rated CEOs for Small and Medium Companies. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

The Nurse Reviewer Clinical Letter Writer (RN) is responsible for reviewing adverse determination decisions against criteria and policy, escalating questions to the physician reviewer, and creating letters that meet regulatory and Plain Language requirements. This position requires a person who can synthesize various clinical and administrative requirements, communicate well with the team and clients, and write clearly.

Responsibilities

  • Reviews adverse determinations against criteria and medical policies

  • Works with the physician reviewer to monitor the adverse determination process and ensure notification timeframes are met

  • Creates adverse determination notifications that meet all accreditation, State, and Federal criteria

  • Uses Plain Language and good written skills to clearly communicate adverse decisions to both members and providers

  • Works with internal and external staff to ensure that decisions are made, documented and communicated clearly

  • Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director.

  • Appropriately identifies potential cases for Care Management programs

  • Communicates appropriate information to other staff members as necessary/required.

  • Participates in continuing education initiatives.

  • Collaborates with Claims, Quality Management and Provider Relations Departments as requested.

  • Performs other duties as assigned.

Qualifications

  • Licensed registered nurse (current and unrestricted)

  • Minimum of three years of direct clinical patient care

  • Minimum of one year of experience with medical management activities in a managed care environment

  • Excellent written skills

  • Knowledge of managed care principles, HMO and Risk Contracting arrangements.

  • Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)

  • Strong interpersonal, oral and written communication skills.

  • Possess basic computer skills

Evolent Health is an Equal Opportunity/Affirmative Action Employer


upload resume icon
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Clinical Educator Pediatric Cardiology

Ascension Health

Posted 2 days ago

VIEW JOBS 1/15/2019 12:00:00 AM 2019-04-15T00:00 We Are Hiring RN Educator - Pediatric Cardiology Services - Full-Time, Day - Dell Children's Medical Ctr - Austin, TX Why Join Ascension? At Seton, we're using the power of purpose to change healthcare for the better. As part of Ascension's Texas Ministry Market we do this through collaboration. Seton brings great minds and proven results from the across the nation together. From the best hires and strategic plans for growth, to the proactive connections we make within our community, we reach out to move ahead. Now, partnering with the University of Texas to build the new Dell Seton Medical Center, our future looks brighter than ever. We do this in force. With more than 12,800 associates, Seton is the leading healthcare service provider in Central Texas as well as its second largest employer. We serve an eleven county area of more than 1.8 million people. We have five urban acute care hospitals, two rural hospitals, a mental health hospital, three primary care clinics for the uninsured, and an increasing number of storefront care locations. We do this with vision. Since our founding in 1902, Seton has led the way in Austin --- expanding thoughtfully and with purpose; caring for our neighbors, because we know them so well. As a non-profit with a mission --- rather than a bottom line --- guiding us, improving health at a community level is our number one priority. Austin. It's our home, and our heart. Located at the center of Texas hill country --- just a few hours from Dallas, Houston, and San Antonio --- Austin offers an appealing blend of hometown comfort and high-tech care. Whether you are looking for a vibrant nightlife and live music, recreational areas and activities, family-friendly fun, or educational offerings, Austin is a city that not only calls to you, but gently encourages you to sit down and stay awhile. With cultural diversity, a mild climate (and truly great outdoors), attractive and affordable housing options, and no state income tax, Austin is a feel-good choice for a rewarding way of life. The way we connect, the lives we affect. The Seton Healthcare Family is always looking for dedicated, talented professionals willing to share their hearts with those we serve. Being part of our close-knit team means performing to a higher standard. Embracing innovation, while understanding the importance of individual connections. And continually collaborating, learning and growing to realize new levels of personal and professional satisfaction. What You Will Do As an Associate with Seton Family of Hospitals-TX, you will have the opportunity to assess, plans, implement and evaluate educational activities related to clinical areas for an assigned service line or population. Responsibilities: * Collaborates with managers and staff to assess learning needs and competencies. * Develops, implements, and evaluates educational plans/programs and utilizes methods, measurements and tools to evaluate achievement of learning goals. * Serves as a resource for staff in areas of program development, clinical practice and professional development. * Participates in the coordination and continuity of orientation programs. What You Will Need Education: * Diploma * High school diploma/GED with 2 years of experience, or Associate's degree, or Technical degree required RN BSN or higher degree preferred * Advanced Nursing certification preferred * Current Registered Nursing license with eligibility to be licensed in Texas * Work Experience: * Pediatric Cardiology experience Preferred * Recent hospital experience (within 2 years) preferred * Clinical Education experience preferred Equal Employment Opportunity Seton Healthcare Family is an equal employment opportunity / Affirmative Action employer and complies with all applicable federal, state and local equal employment regulations and laws. It is the policy of the Seton Healthcare Family to afford equal employment opportunities to all employees and prospective employees without regard to their race, color, ancestry, religion, sex, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, gender identity or expression, or any other characteristic or status that is protected by federal, state, or local laws. This policy applies to all personnel actions, such as hiring, promotion, transfer, demotion, termination, layoff and all other conditions and privileges of employment in accordance with applicable federal, state, and local laws. Affirmative Action goes beyond the concept of equal employment opportunity. Affirmative Action policies and programs are required to overcome the present effects of past discrimination and to achieve equal employment opportunity for members of groups that are or have been formerly under-represented. Affirmative Action policies and programs are tools whereby additional efforts are made to recruit, employ and promote qualified members of formerly excluded groups, even if that exclusion cannot be traced to particular discriminatory actions. Through specific and result-oriented activities, Seton Healthcare Family's goals are to ensure that every person is given full consideration through equal employment opportunity policies and practices and to achieve a representative workforce through its affirmative action efforts. It is further the policy of the Seton Healthcare Family to encourage vendors, contractors, affiliate institutions and others doing business with the Seton Healthcare Family to observe the principles of Equal Employment Opportunity and Affirmative Action. Seton Healthcare Family is an EEO/AA employer: M/F/Disabled/Vet. For further information regarding your EEO rights, click on the following link to the "EEO is the Law" poster: http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf EEO is the Law Poster Supplement http://www.dol.gov/ofccp/regs/compliance/posters/pdf/ofccp_eeo_supplement_final_jrf_qa_508c.pdf Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. Ascension Health Austin TX

Clinical Letter Writer, UM RN

Expired Job

Evolent Health, Inc.