Clinical Reviewer, Radiation Therapy

Evolent

Clinical Reviewer for Radiation Therapy at Evolent ensuring appropriate utilization and quality of care. Collaborating with healthcare providers while adhering to guidelines and HIPAA compliance.

Posted 7/6/2026full-timeRemote • 🌎 Anywhere in the WorldJuniorMid-Level💰 $38 - $39 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

American Registry of Radiologic Technologists (ARRT) certification is current and in good standing in your home state. ( Required)
Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel. ( Required)
Able to work in a fast-paced environment, and demonstrate excellent problem-solving, critical thinking, and organizational skills. ( Required)
Strong computer skills in Microsoft Office programs as well as EMR, SharePoint, and website navigation and email organization. - Required
Required shift of 9:30AM - 6:00PM PST M-F, occasional weekends and holidays required with advance scheduling. - Required
2 - 4 years UM experience - Preferred

Benefits

Comp & perks

health insurance benefits

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Utilization ManagementCoding AccuracyClinical Guidelines ComplianceDocumentation ReviewMedical Review Criteria Application

Soft Skills

Verbal CommunicationWritten CommunicationOrganizational SkillsCritical ThinkingInterpersonal Skills

Certifications

ARRT Certification