Manager, Utilization Management (RN)

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.

The Client Services team offers candidates the opportunity to positively impact member’s care daily. Our clinical operations team possess a can-do spirit, as they will wear multiple hats throughout the day working through different scenarios to ensure members and providers receive decisions timely. We believe in creating opportunities for our staff to grow, so the candidate must be passionate about leading, coaching and motivating. We are a team of leaders who accomplish our mission through valuing people, providing resolutions, driving results, and collaborating with others. Collaboration Opportunities: The Manager, Client Services oversees daily utilization management and directs the medical care of our members on behalf of our health plans and serves in a supporting role to the Director, Intake and Utilization Management Operations. This individual will not only lead a production team but will also work closely with our cardiology and oncology clinical teams on a regular basis. Opportunities to work collaboratively with other intake leaders across the organization, training and development, provider relations, member services, claims management and our implementation team will also be available.

Through daily monitoring, meets health plan baseline Service Level Agreements and Turnaround Timeframes related to inventory management. Addresses issues with the potential of missing an SLA or TAT timely. Responsible for monitoring utilization management resources, incoming provider requests, implementation of initiatives, and educational processes to achieve targeted utilization management results established at both the health plan and department level. Supports the daily needs of a production-based team which may include up to 25 Client Service Coordinators. Tasks typically include hiring, coaching, monitoring progress towards objectives and key results, etc. Responds to inquiries and escalations from our health plans, providers and internal leaders promptly providing next steps or resolutions. Responsible for directing activities related to special projects for utilization management and use of project resources.