Evolent

Business Development Rep

• Engage and lead same-store growth efforts with health plan clients
• Develop data driven approaches to engage key accounts
• Manage the complete sales journey
• Provide input and guidance on materials/decks for client meetings
• Oversee client research to facilitate deal qualification

Director, Business Development

Director

• Lead an analytics, reporting and data science team supporting the performance of Evolent’s primary care business
• Connect analytic insights to company strategy within business development, technology strategy and operations optimization
• Monitor and synthesize relevant CMS policies and their implications to the business
• Recommend changes to the physician incentive models and/or growth strategy as appropriate
• Design and oversee the team running statistics-based internal evaluations on various business areas and products
• Develop and implement Key Performance Indicators (KPIs) to drive performance in Care Management operations
• Manage executive level report-outs of Evolent Care Partners’ business unit performance
• Develop close working relationships with peers and leaders across Evolent’s clinical, operations, actuary, risk adjustment and IT teams

Senior Director, MSSP ACO Strategy – Performance Analytics

Medical Director

• Serve as the specialty match reviewer in Vascular 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
• Provides clinical rationale for standard and expedited appeals
• 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
• Participates in on-going training per inter-rater reliability process
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process

Field Medical Director, Vascular Surgery

• Lead Evolent’s Scope Management Transformation, establishing clear ownership, accountability, and execution across implementations, scope changes, and business operations.
• Drive enterprise‑level change by translating strategy into executable roadmaps that improve decision speed, consistency, and quality.
• Provide end‑to‑end leadership for complex, cross‑functional initiatives, including new market and product implementations and large‑scale scope changes.
• Own delivery from planning through execution, actively managing risks, dependencies, and tradeoffs while driving timely decisions in ambiguous and high‑stakes environments.
• Ensure scope decisions are clearly documented, operationalized, and embedded into downstream systems, workflows, and operating models.
• Serve as a strategic thought partner to senior leadership on scope strategy, priorities, and long‑term capability building.
• Partner closely with leaders across Clinical, Product, Finance, Performance, Technology, Implementation, and Strategic Accounts to align scope decisions with clinical, financial, and operational objectives.
• Lead and support formal scope governance and change forums, enabling structured, rules‑based decisioning and clear cross‑functional accountability.
• Establish and reinforce standardized approval criteria and decision frameworks to reduce rework, escalation, and variability in outcomes.
• Oversee scope activities tied to new client, market, or line‑of‑business implementations, ensuring alignment from decision through execution.
• Drive cross‑functional clarity by ensuring scope changes are translated into actionable operational requirements and consistently applied across teams and platforms.
• Lead, mentor, and develop Scope Management leaders and team members, fostering a culture of accountability, ownership, and continuous improvement.
• Monitor operational health, backlog, and delivery performance, ensuring work is prioritized against enterprise impact.
• Identify opportunities to improve efficiency, scalability, and quality through process standardization, documentation, and enablement.

Director – Scope Management

• Support pre-admission review, utilization management, and concurrent and retrospective review process.
• Participate in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs.
• Assist with execution of Evolent's benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs.
• Participate in the Appeals and Grievance process, as necessary, to assure timely and accurate responses to members.
• Support design and implementation of health plan medical policies, and appropriate Care Management and UM goals and objectives.
• Provide clinical leadership and development for population health programs or functional areas within Medical Management.
• Assist in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
• Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers.
• Participate in committees as assigned.
• Provide guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.
• Evaluate and ensure systems and processes to assist providers with adherence to evidence based protocols.
• Assure compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.

Field Medical Director, UM Physical Medicine

• Serve as the Physician match reviewer in Radiation Oncology and imaging cases
• Discuss 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
• Participates in on-going training per inter-rater reliability process.

Field Medical Director, Radiation Oncology

• Serve as the specialty-match reviewer for diagnostic cardiology cases
• Review all cases in which clinical determinations cannot be made by Initial Clinical Reviewers
• Provide clear, evidence-based clinical rationale for standard and expedited appeals
• Conduct peer-to-peer discussions with requesting physicians or ordering providers
• Utilize medical and clinical review guidelines and parameters to ensure consistency in physician review processes
• Assist and act as a clinical resource to Field Medical Directors and Initial Clinical Reviewers
• Ensure all communications with medical office staff and/or physician providers are documented accurately
• Participate in ongoing training initiatives
• Assist the Senior Medical Director with research activities and questions
• Review appeal cases and/or attend hearings to support utilization management determinations
• Function as Medical Director for select health plans or regions as requested

Field Medical Director – Internal Medicine, Emergency Medicine, Cardiology

Business Intelligence Developer

• A BI Engineer assists with the creation of repeatable reporting assets
• Design and develop BI reporting and data platforms
• Creates the development of user-facing data visualization and presentation tools, including but not limited to Microsoft SQL Server Reporting Services (SSRS) reports, Power BI dashboards, MicroStrategy and Excel PivotTables
• Work on the development of data retrieval and data management for Evolent Health
• Support in ensuring that the BI data assets of the organization are aligned with the organization in achieving its strategic goals
• Help implement effective business analytics practices to enhance decision making, efficiency, and performance
• Assist with technology improvements to ensure continuous enhancements of the core BI platform
• Ability to perform complex data analysis using advanced SQL skills and Excel to support internal /external client’s data requests and queries for ad-hoc requests for business continuity and analytics
• Communicate with non-technical business users to gather specific requirements for reports and BI solutions
• Provide maintenance support for existing BI applications and reports
• Present work when requested and participate in knowledge-sharing sessions with team members

BI Engineer, BI Center of Excellence

Accountant

• Oversee accounting transactions across range of business processes
• Assist in month end close (e.g., post journal entries)
• Prepare monthly account reconciliations
• Prepare variance analysis
• Prepare quarterly internal controls documentation
• Support the quarterly and annual financial statement audits with auditors
• Work with multiple project teams across the company
• Participate in special projects

Senior Accountant

• Partner closely with leadership to shape, refine, and communicate the long‑term vision and strategy for MSK/RBM specialty solutions
• Translate strategy into execution to evaluate opportunities, define priorities, and guide decision‑making across the performance portfolio
• Lead new performance initiatives through all phases of design and execution
• Collaborate cross‑functionally with clinical, operational, analytics, product, and client‑facing teams
• Monitor key performance metrics and solution outcomes

Director, MSK/RBM Performance

Financial Planning and Analysis

• Overseeing the company’s budgeting, forecasting, financial reporting, and cash flow planning processes.
• Partnering closely with leadership to provide actionable financial insights.
• Leading enterprise-wide financial planning processes and enhancing reporting capabilities.
• Developing financial models to support strategic decision-making.
• Preparing executive-level reporting packages and delivering actionable commentary to senior leadership.
• Developing and maintaining 13-week cash flow forecasts.

Senior Director, Financial Planning and Analysis

Account Manager

• The Account Manager will have a unique insight to the various idiosyncrasies to the individual markets and be directly and indirectly responsible for their outputs.
• Collaboration Opportunities: Serving as a consultative partner, helping to identify opportunities for growth within health plan specialty management and Evolent.
• Partner with Evolent central Strategic Account resources to implement relationship best practices and drive value communication and satisfaction at all levels of the partner organization.
• Proactively manage client operational end to end resolution in a timely manager. Client-facing for all associated role responsibilities.
• Development and management of monthly, quarterly, and annual client reporting. In addition to quality review and client Q & A reporting.
• Understand and monitor performance to PG/ SLA expectations.
• Track and/or monitor a client’s requirements/projects to the agreed upon specifications.
• Run efficient/effective meetings and work sessions with the client and all relevant Subject Matter Expert (SME).
• Take a proactive approach to managing the client and anticipating needs to ensure satisfaction and a continued business relationship.
• Maintains a sound knowledge of the client’s business and a comprehensive knowledge of Evolent’s specialty products and services.
• Demonstrate general awareness of standardized and documented Evolent structure, functional objectives, and capabilities to manage client expectations.
• Serve as a liaison between the client and key Evolent stakeholders related to issues, client projects and initiatives.
• Collaborate with internal stakeholders to resolve issues or find solutions.
• Utilize Evolent systems and tools to effectively field questions and manage client requirements efficiently (i.e. reporting, eligibility files, provider files).
• Review and validate accuracy of client deliverables prior to external distribution.

• Supports an assigned book of business to achieve objectives, including relationship, growth, retention, and customer goals.
• Cultivates productive, trusted relationships with day to day client contacts, and leaders across external and internal teams.
• Utilizes data-driven resources to run efficient/effective meetings and work sessions with the client and all relevant Subject Matter Expert (SME)s.
• Possess working knowledge of Evolent products and services and can articulate value proposition for all at a high level.
• Develops best-in-class presentation strategies and content for senior stakeholder engagements.
• Implements relationship best practices and drive value communication across partner organizations.
• Collaborates with internal team to develop materials and strategy for regular partnership reviews, including relationship mapping, issue identification, and action planning.
• Proactively manages risks and identify opportunities within current client relationships.
• Collaborate cross functionally to monitor issue resolution and ensure timely follow-up.
• Maintain big picture view of client health, owning internal process around issue resolution via internal ticketing system and email traffic.
• Advocate for the client(s) within Evolent, serving as an ambassador within Evolent and the go-to expert on client priorities and how to get things done within the health plan organization.
• Manage all aspects of client contracts, including SLA performance, benefit analysis, and regulatory compliance.

Associate Director, Strategic Accounts

Medical Billing and Coding

• The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with the Plans’ provider agreements and the National Healthcare Billing Audit guidelines.
• Work with SIU Investigators assisting in research, discuss to make appropriate coding determinations as needed
• Analyze and interpret patient medical records (behavioral related and other specialties) pertaining to FWA investigations as needed
• Compare information submitted on the claims to determine amount and nature of billable services as needed
• Determines appropriateness of billing and reimbursement as needed
• Documents findings for each claim line in a spreadsheet as needed
• Summarize findings in a written report as needed
• Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed
• Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed
• Perform data analysis and lead generation/data mining of client data as needed
• Provide Subject Matter Expertise and SIU support to clients as needed
• Comply with Privacy and Security standards
• Understands and complies with all company Privacy and Security standards