Clinical Reviewer, Nurse Practitioner/Physician Assistant – Vascular Surgery
Evolent
part-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $68 - $74 per hour
About the role
- 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 Medical Therapy including communicating with offices recommendations regarding medical therapy.
- 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 Vascular Surgeons or Cardiologists.
- 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 New Century Health 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 UM 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.
Requirements
- Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized degree program OR a master’s degree from a program accredited by the ARC-PA
- Minimum of five (5) years’ experience in the practice of Vascular Surgery (preferred) or primary care; knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred)
- Current, unrestricted state PA or RN/NP license in medicine or required specialty
- Of a PA, obtaining a passing score on a national certifying exam
- Obtaining and maintaining required licenses in the states where NCH has business
- Strong clinical, management, communication, and organizational skills
- Demonstrated leadership skills
- Analytic skills
- Energetic and curious with a passion for quality and value in health care
- Required to pass skills proficiency test
Benefits
- comprehensive benefits (including health insurance benefits)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical reviewmedical necessity decisionsGuideline Directed Medical Therapypeer clinical reviewregulatory requirementsVascular Surgeryprimary careskills proficiency test
Soft skills
communicationorganizational skillsleadership skillsanalytical skillsinterdepartmental liaisonclient satisfactionintegrityrole model
Certifications
Master of Science in NursingDoctor of Nursing Practicestate PA licenseRN/NP licensenational certifying exam