Evolent

Director

• Serve as the primary relationship owner for assigned vascular groups within the respective market, including interventional cardiology groups that do vascular procedures
• Cultivate productive, trusted relationships with key health plan and provider group executives, including C-level clinical and administrative leadership
• Lead practice transformation initiatives to advance quality, efficiency, and patient outcomes in alignment with value-based care objectives
• Strategically build clinical and administrative leadership relationships to support business development activities across key health systems and vascular groups
• Use advanced analytics to inform engagement strategies, monitor performance, and identify opportunities for improvement
• Cultivate productive, trusted relationships with key health plan and provider group executives, including C-level clinical and administrative leadership
• Partner with vascular group leadership to build change management processes and support the practice pull-through activities needed to drive change at scale through effective project management
• Influence internal clinical and operational changes through effective communication, facilitation, and influence with practice leadership, physicians, APPs, and practice administrators
• Develop and deliver compelling leadership presentations to clinical and executive audiences to drive alignment and accountability
• Manage multiple markets, prioritizing and scaling engagement efforts to optimize program impact
• Quarterback initiatives and collaborating cross-functionally with internal teams (i.e., product, medical, strategic accounts), to support practice needs, launch new high-value initiatives
• Facilitate vascular group education and training related to new quality initiatives, partnering with relevant Evolent clinical subject matter experts, and various technology integrations and platforms
• Partner with internal clinical and medical teams to ensure alignment with the corporate cardiovascular strategy
• Partner with Provider Engagement/Experience Market Managers to ensure successful adoption and engagement of Evolent’s solutions (i.e., prior authorization, clinical pathways) to ensure timely patient access to care and drive high provider satisfaction, measured by CSAT and NPS scores
• Support the development and execution of innovative engagement opportunities such as regional clinical symposiums and local provider experience advisory panels
• Partner with Evolent Strategic Account teams and payer clients to align priorities and deliver high-quality provider network engagement, performance reporting, and present to health plan clients
• Maintain detailed records of practice interactions, progress on transformation, initiatives, and market trends
• Representing the organization at regional forums/clinical symposiums, conferences, and support business growth opportunities

Director, Provider Engagement – Vascular

Engineering Manager

• Assist in managing day-to-day activities of the software engineering team, ensuring alignment with project goals and timelines.
• Provide technical guidance and mentorship to team members to support their professional growth.
• Collaborate with stakeholders to gather requirements, define project scope, and create technical roadmaps.
• Oversee the design, development, and deployment of scalable software solutions.
• Conduct code reviews to ensure adherence to best practices, quality standards, and coding guidelines.
• Participate in troubleshooting and resolving software issues to maintain system performance and reliability.
• Promote the adoption of agile methodologies and contribute to continuous process improvements.
• Prepare and present project status updates to leadership and stakeholders.

Manager, Software Engineering

Artificial Intelligence

• Owns the analytics AI roadmap and helps drive adoption of AI-enabled workflows across Evolent’s analytics organization.
• Represent Analytics on the AI Governance committee, define how to evaluate and prioritize AI use cases, and lead transformation initiatives.
• Lead execution of Analytics AI strategy and roadmap and prioritize automation opportunities across analytics teams.
• Lead delivery of AI transformation initiatives including automation, self-service tools, compliance reporting, and client value intelligence.
• Partner with Product Analytics and Data Science to identify and implement meaningful AI use cases.
• Measure effectiveness through KPIs tied to outcomes, efficiency, and cost.
• Translate ASC 350-40 into a practical way to track development work so Finance can apply capitalization rules.
• Design and implement the consolidated data layer using Microsoft Fabric.
• Enable access to platforms such as Azure OpenAI, DevOps, and Power BI APIs.
• Build Copilot adoption programs and prompt playbooks for analysts.
• Create intake models that route standard requests to self-service tools first.
• Quantify ROI through time savings, capacity freed, and effectiveness gains.
• Manage and develop a team of automation analysts and developers.

Director, AI Transformation

• Build Microsoft Fabric pipelines and consolidated Lakehouse models.
• Develop certified views with reconciled metric definitions.
• Engineer Azure OpenAI prompts for narrative and insight generation.
• Build Python-based automation for reporting and compliance workflows.
• Support self-service analytics platforms with text-to-SQL and routing logic.
• Implement automated compliance and validation checks.
• Build signal detection and alerting pipelines.
• Track and analyze AI-driven program effectiveness.
• Maintain build logs and time tracking aligned to ASC 350-40.
• Create Copilot prompt playbooks and best practices.
• Monitor pipeline health and resolve data issues.
• Support Power BI automation and DAX libraries.

Senior Analyst, AI Transformation

Medical Director

• Serve as the Physician match reviewer in Imaging cases
• Discuss determinations with requesting physicians or ordering providers
• Utilizes medical/clinical review guidelines
• Aids and acts as a resource to Initial Clinical Reviewers
• Ensures documentation of all communications is recorded
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process

Physician Reviewer, Internal Medicine – Field Medical Director, Radiology (Part Time)

• Currently seeking Endocrinologist Physicians to join our Radiology department
• As an FMD, Radiology you will be a key member of the utilization management team.
• Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
• Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
• Aids and acts as a resource to Initial Clinical Reviewers.
• Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
• Participates in on-going training per inter-rater reliability process.

Endocrinology Physician Reviewer – Field Medical Director, Radiology

• Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available
• Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process
• Aids and acts as a resource to Initial Clinical Reviewers
• Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process

Otolaryngologist, Physician Reviewer – Field Medical Director, Radiology

Data Engineer

• Develop and execute the strategic vision for Client Data Engineering, aligning technical investments and delivery priorities with business goals, client commitments, and product strategy
• Lead the engineering teams responsible for client data ingestion, outbound data delivery, interface development, implementation support, and production support across provider, member, authorization, claims, and related client data domains
• Partner closely with Product leadership to refine business and client requirements, improve requirement quality, and ensure engineering teams receive clear, actionable, and appropriately scoped work
• Work directly with clients, implementation teams, and internal stakeholders to clarify technical requirements, identify risks and dependencies early, and scope client support requests so implementations happen on time and client satisfaction remains high
• Drive successful client implementations by improving data readiness, validation practices, delivery predictability, and coordination across engineering, product, implementation, and operations teams
• Establish clear ownership, operating models, and engagement patterns for Client Data Engineering teams so internal partners know how to engage the organization effectively and critical work is routed to the right teams
• Lead the modernization of client data exchange capabilities, including migration of legacy interfaces and EDI-related workflows to more standardized, maintainable, and scalable platforms and patterns
• Provide strategic direction for healthcare data integration capabilities, including EDI/X12 transactions, client-specific file interfaces, data movement across operational platforms, and evolving interoperability approaches such as FHIR-enabled architectures where appropriate
• Ensure strong governance of software engineering and data engineering practices across the organization, including design, testing, release management, production readiness, support processes, and operational accountability
• Monitor and improve delivery, quality, and operational performance through the use of metrics, service health indicators, implementation outcomes, and continuous improvement practices
• Build strong cross-functional relationships with Product, Client Delivery, Implementation, Operations, Architecture, Infrastructure, and other Engineering teams to resolve issues quickly and deliver value-driven solutions
• Lead and mentor directors, senior directors, managers, and technical leaders within Client Data Engineering, building a culture of accountability, collaboration, technical excellence, and customer focus
• Drive organizational planning, staffing, and talent development for a geographically distributed team, including contractor and vendor strategy where needed to support business priorities
• Represent Client Data Engineering in executive discussions and broader organizational planning, communicating priorities, risks, dependencies, progress, and strategic recommendations effectively.

Managing Director, Client Data Engineering

Medical Reviewer

• Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff.
• Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process.
• Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria.
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff.
• Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes.
• Documents all communication with medical office staff and/or treating provider.
• Practices and maintains the principles of utilization management by adhering to policies and procedures.
• Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately.

Clinical Reviewer, Nurse – Radiology

• Currently seeking Family Medicine Physicians to join our Radiology department.
• Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
• Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
• Aids and acts as a resource to Initial Clinical Reviewers.
• Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
• Participates in on-going training per inter-rater reliability process.

Family Medicine Physician Reviewer – Field Medical Director, Radiology

Analyst

• The Analyst, Performance Suite Analytics utilizes and develops analytic tools to solve complex business challenges as well as support decision making that can have a considerable impact on the organization and patient health.
• This role will support the Medical Cost Management activities, working in a Medical Economics team that supports Business Development and new product efforts.
• Support the underwriting of capitated risk proposals involving cost & use projections, trend selection/development, and estimation of Evolent’s ability to reduce cost and improve quality.
• Support the design of financial arrangements that are equitable for both Evolent and our Partners.
• Support the development of models and approaches aimed at quantifying and articulating our value.
• Perform research and analysis of complex healthcare claims, eligibility, and pharmacy data to make recommendations based on relevant findings.
• Draw actionable conclusions from analyses and effectively communicate to internal/external audiences at various levels of the enterprise.
• Translate analyses into Customer-ready deliverables using available visualization tools.
• Provide support and facilitate interaction with customers in a manner that fosters expertise and cooperation.
• Process and validate raw unadjudicated claims data.
• Use programming skills to explore, examine and interpret large volumes of data in various forms to complete deliverables with minimal assistance and oversight.

Analyst, Performance Suite Analytics

• Lead Analytics Strategy & Impact Define and execute the analytics strategy for Evolent, aligned to organizational goals and the MCAP Gain Share agreement.
• Monitor performance indicators, identify emerging trends, and surface opportunities for operational, clinical, and financial improvement.
• Advance value‑add analytics offerings using enterprise capabilities such as clinical data marts and risk‑score assets.
• Deliver Actionable Insights Serve as a trusted advisor to internal and external partners, translating complex data into clear insights and practical recommendations.
• Present findings through polished, executive‑ready narratives that inform strategy and drive decision‑making.
• Lead delivery of both standard reporting and high‑impact ad‑hoc analyses across medical economics, membership, and specialty analytics.
• Build and Mentor a High‑Performing Team Manage and develop a geographically distributed team of analysts, promoting collaboration, innovation, and continuous improvement.
• Drive clarity, structure, and prioritization across workstreams, ensuring high‑quality output and effective capacity management.
• Foster a culture of technical excellence, curiosity, and professional growth.
• Scale Analytics Capabilities Lead development of automated solutions, scalable data products, and reusable analytical frameworks.
• Oversee quality assurance and ensure accuracy, consistency, and reliability of all analytics deliverables.
• Improve team processes and leverage Agile or similar project delivery methodologies to drive execution efficiency.

Director, Client Analytics

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Senior Analyst, Performance Suite Analytics

Operations

• Manage proprietary application workflow, daily product/ data operation and support key systems, functionalities including web-based applications.
• Lead operations for software services and support key clients in operational efforts, including defect management for business Operations.
• Own the Incident Management 2.0 process and implement process for the Organization.
• Manage Tier 2 support team, lead daily standup, and oversee day-to-day operations.
• Collaborate with internal stakeholders, including team members from Production Operations, Engineering, and other Business stakeholders where necessary for resolution of issues.
• Define central testing strategy and validate test plans across workstreams.
• Build new ticket platforms using Jira and Salesforce and end to end validation for functionality.
• Perform SQL queries on relational database for data validation, identify relationships, facts, and dimensions.
• Perform system, unit, performance, load, regression, stress, and data interface testing.
• Determine common source of errors and iterate the build to production environment.
• Participate in Release and Bug-Review meetings with QA and product managers.
• Supervise a team of seven junior software developers.
• Mentor, develop and coach team junior members to increase their effectiveness and engagement.
• Partner with the Site Reliability Engineering team and bridge the gap between IT operations while focusing on automating infrastructure & monitoring domains/systems.

Associate Director – Technical Operations

• 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.
• 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 recommendation.
• 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.