Clinical Reviewer, Radiation Therapy

Evolent

Clinical Reviewer in Utilization Management at Evolent, advocating for member care and collaborating with healthcare professionals. Reviewing documentation and ensuring compliance with clinical guidelines in a fast-paced environment.

Posted 7/22/2026full-timeRemote • Alaska, Arizona, California • 🇺🇸 United StatesJuniorMid-Level💰 $38 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Management, ensuring compliance with regulatory guidelines and effective communication with providers. Proficient in applying clinical guidelines and maintaining accurate documentation while advocating for member services.

Highest-signal resume keywords

Utilization Management ExperienceARRT CertificationEffective Communication SkillsMicrosoft Office ProficiencyProblem-Solving Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Utilization ManagementClinical Guidelines ApplicationDocumentation AccuracyRegulatory ComplianceMedical Review Criteria

Soft Skills

Verbal CommunicationWritten CommunicationOrganizational SkillsCritical ThinkingInterpersonal Skills

Tools & Technologies

EMRSharePointMicrosoft OfficeWebsite NavigationEmail Organization

Certifications & Qualifications

ARRT Certification

Industry Keywords

HIPAA ComplianceProvider RelationsCost-Effective CareFast-Paced EnvironmentDocumentation Guidelines

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.
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.

Requirements

What you’ll need

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

Benefits

Comp & perks

Health insurance benefits