Evolent

Medical Reviewer

• To ensure the appropriate utilization of services act as an advocate for our members and to ensure the highest quality and cost-effective care.
• Reviews Provider request 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.
• Verifies accuracy of codes and services and applies them accurately with appropriate documentation.
• Ensures regulatory guidelines are met for timeliness and use of medical review criteria.
• 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 and not limited to develop report data elements.

Clinical Reviewer, Radiation Therapy

Medical Director

• Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers
• 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
• Participates in on-going training per inter-rater reliability process

Field Medical Director, MSK Surgery

• Responsible for supporting and assisting all cardiology administrative and clinical utilization management and quality improvement functions
• Act as a clinical liaison to providers, clients, and patients
• Maintain and operate Guideline Directed Medial Therapy
• Communicate clinical information needs to ordering providers
• Prep cases for P2P discussions
• Coordinate with UM staff for communication of clinical decisions
• Complete UM projects and participate in site visit reviews
• Serve as subject matter expert in assigned meetings

Clinical Reviewer, Electrophysiology NP/PA

Analyst

• Supporting operational excellence for our health plan book of business, including but not limited to project support, ticket management, issue resolution, SLA and CAP management; reviewing utilization trends, best practices and identifying opportunities for improved reporting.
• Work with stakeholders to understand business needs, proactively clarify requirements, and develop actionable recommendations.
• Enhance and standardize reporting analytical solutions for internal teams and external partners.
• Support ad hoc and regulatory reporting needs efficiently, ensuring compliance with applicable guidelines.
• Present findings in client-facing decks, data-driven narratives, and visualizations that convey insights effectively.
• Partner with internal stateside and global teams to deliver high-quality analyses.

Strategic Accounts Analyst

• 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 Radiation Technologist in the Utilization Management department, you will work closely with other nurses, managers, medical directors, and upper leadership as requested.
• Reviews Provider request 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 accuracy of codes and services and applies them accurately with appropriate documentation.
• Ensures regulatory guidelines are met for timeliness and use of medical review criteria.
• 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 and not limited to develop report data elements.

Full-stack Engineer

• Evolent is seeking a Software Engineer to join an Agile team building healthcare‑focused backend software solutions that support analytics, integration, and operational workflows across the healthcare ecosystem.
• In this role, you will design and develop scalable backend services using Python and FastAPI, and build event‑driven and serverless solutions leveraging Microsoft Azure services such as Azure Functions and Azure Event Hub.
• You will also develop and maintain data ingestion pipelines that load healthcare data into Microsoft Fabric to support enterprise reporting and analytics needs.
• Team members contribute across the full software development lifecycle and are expected to wear multiple hats.
• You will participate in architecture and design discussions, author and review design documentation, and implement high‑quality, maintainable code.
• You will collaborate closely with product owners, QA partners, and fellow software engineers in an Agile environment, contributing to sprint planning, stand‑ups, retrospectives, and iterative delivery.
• As needed, you will assist with testing, debugging, and validation to ensure solutions meet quality, performance, and regulatory expectations.
• The role includes modernizing and optimizing existing systems, including performance tuning legacy SQL stored procedures to improve efficiency and scalability.
• You will use GitHub workflows to support CI/CD pipelines, code reviews, and automated quality checks, and write unit tests to improve code coverage and maintainability.
• The ideal candidate is comfortable working in a fast‑paced healthcare technology environment, brings strong backend engineering fundamentals, and actively leverages Copilot and other AI‑assisted tools to solve complex problems and improve developer productivity.

Software Engineer

Product Manager

• Lead and manage AI initiatives across the organization
• Conduct in-depth opportunity analysis for new and existing AI initiatives, including business case development and feasibility assessment
• Drive expansion of a core product area, including growth across lines of business and specialties, and support of new use cases
• Translate key business insights, data science insights, and model outputs into scalable product features
• Collaborate with data science teams to outline proof-of-concepts (POCs)
• Evaluate the success of AI initiatives at the POC stage gate
• Drive alignment across engineering, data science, clinical, and operations stakeholders to deliver cohesive solutions
• Define, monitor, and act on key performance metrics to inform business impact, prioritization, and continuous improvement
• Communicate results and insights to executive stakeholders

Senior Product Manager – AI, Healthcare Innovation

Artificial Intelligence

• The Senior Analyst, AI Transformation is a hands-on builder who designs and deploys AI-enabled analytics workflows.
• This role blends analytics engineering, automation, and practical AI implementation.
• This role works directly on the technical execution of transformation initiatives.
• 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

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.

Clinical Reviewer, Radiation Therapy

Field Medical Director, MSK Surgery

Clinical Reviewer, Electrophysiology NP/PA

Strategic Accounts Analyst

Clinical Reviewer, Radiation Therapy

Software Engineer

Senior Product Manager – AI, Healthcare Innovation

Senior Analyst, AI Transformation

Director, Provider Engagement – Vascular

Manager, Software Engineering