Evolent

Director

• 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

Medical Coder, Program Integrity

Full-stack Engineer

• Provide strategic leadership and technical direction for Evolent’s software engineering organization.
• Oversee modernization efforts, unify legacy platforms, and drive adoption of scalable solutions.
• Collaborate closely with stakeholders across Engineering, Product, and business teams.
• Foster a culture of quality, customer obsession, product mindset, and technical excellence.
• Develop a high-performing team that embraces learning, innovation, and accountability.
• Drive modernization of platforms and processes to reduce complexity.
• Engage stakeholders to understand business needs deeply and influence progress.

Senior Director, Software Engineering

Medical Reviewer

• Conducts initial clinical review of incoming cases, rendering authorization approval based on established clinical criteria or escalating to a Field Medical Director if authorization cannot be approved during initial review.
• 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 Treatment plans including communicating with offices regarding treatment recommendation.
• 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 Oncologists.
• 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 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 Clinical Operations 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.
• Performs other duties as assigned.

Clinical Reviewer, Nurse Practitioner / Physician Assistant – Oncology

Medical Director

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Field Medical Director, Oncology

• Serve as a key member of the Utilization Management team providing clinically sound medical reviews for cardiology-related service requests
• 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
• Utilize medical and clinical review guidelines to ensure consistency in physician review processes

Field Medical Director, Internal Medicine/Emergency Medicine - Cardiology Team

Communications

• Write, format, proofread and distribute communication materials (e.g., newsletters, intranet content, executive messages, email updates, videos, decks, etc.)
• Maintain internal communications channels including Evolent’s intranet, communications inbox and calendar, and recurring publications, among other channels.
• Gather and plan communications content such as employee, customer and patient stories for larger company campaigns.
• Produce all-company meetings including town halls, office hours and other informational sessions.
• Support internal campaigns through messaging and coordinated rollout plans related to culture initiatives, change management and company policy.
• Collaborate with cross-functional teams to support change management communications, often acting as the communications team representative to these groups as needed.
• Provide logistical and creative support for internal events, town halls, senior leadership meetings, and employee recognition initiatives.

Internal Communications Coordinator

• Lead and manage a team of medical oncologists responsible for reviewing oncology cases.
• Establish clear performance expectations, monitor quality and efficiency, and provide coaching to support professional growth.
• Drive accountability across the team while fostering a culture of collaboration, clinical rigor, and continuous improvement.
• Actively participate in engagement sessions with oncology practices, sharing best clinical practices and supporting broader adoption of evidence-based pathways.
• Foster trusted peer relationships with oncologists to encourage sustainable behavior change that improves patient outcomes.
• Collaborate with Evolent’s clinical leadership on the design, build, and execution of new value initiatives in oncology.
• Document peer interactions and clinical decisions in a timely and accurate manner.

Medical Director, Medical Oncology

Product Manager

• Drive the strategy, design, and delivery of innovative technology solutions for Utilization Management and prior authorization applications.
• Lead agile teams, collaborate across functions, and ensure product compliance.
• Define and communicate product vision, strategy, and roadmap for UM and provider portal solutions.
• Translate strategic goals into actionable product requirements using data and stakeholder feedback.
• Serve as a Subject Matter Expert (SME) for UM workflows, overseeing product documentation processes.
• Build strong relationships with clinical operations and engineering teams to meet end-user needs.
• Identify initiatives to improve efficiency and compliance in workflows.

Senior Product Owner

Actuary

• Develop analytic tools and assist in pricing specialty risk products
• Complemented by monthly reserve management for key clients
• Perform financial analyses to support key partners
• Perform data analyses and financial simulations to support leadership’s pursuit of new specialty business
• Assist in the development of underlying pricing assumptions
• Develop actuarial models for use across multiple teams and projects
• Streamline processes to improve efficiency of key deliverables
• Communicate actuarial concepts and concerns within actuarial department
• Play a key role in Evolent’s future partnerships to change the way healthcare is delivered

Analyst, Actuarial Services

Vice President

• Responsible for leading cardiology and vascular-related utilization management, quality improvement, and clinical operations
• Ensures consistent, high-quality adjudication of cardiology decisions
• Serves as a strategic liaison between clinical teams and clients
• Leads the development of Evolent’s cardiovascular medicine programs
• Rapidly scale cardiovascular programs across current and future clients
• Partner closely with Evolent’s Growth and Strategic Accounts teams for executive partnership with cardiovascular physician executives from clients
• Deepening Evolent’s business partnerships and providing key insights for better clinical outcomes, provider experience, and client value

VP, Cardiovascular Medicine

• Perform data analyses and financial projections that impact pricing, risk assumptions, and strategic decisions.
• Develop and maintain actuarial models for use across multiple teams and projects.
• Contribute to researching, developing, and updating actuarial assumptions using advanced statistical methods and software.
• Assist in implementing automation and process improvements to streamline workflows and reduce manual effort.
• Support the Modeling and Innovation team in building tools and frameworks that enable actuarial teams to focus on insight rather than data wrangling.
• Collaborate with Clinical, Finance, Analytics, Operations, and Provider Engagement teams to integrate actuarial insights into broader strategies.
• Communicate complex actuarial concepts clearly to both technical and non-technical audiences.
• Conduct ad hoc analyses to answer specific business questions from leadership and clients.
• Play a supporting role in initiatives that transform provider partnerships and improve healthcare delivery.

Senior Analyst, Actuarial Services

• Serve as the Physician match reviewer in Radiation Oncology
• 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 to reflect appropriate utilization
• 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

Field Medical Director, Radiation Oncologist

• Lead the design, development, and deployment of complex software solutions, ensuring scalability and maintainability.
• Architect and implement high-performance APIs and microservices that support critical business functions.
• Collaborate closely with cross-functional teams, including product managers, UX designers, and other engineers, to translate business needs into technical solutions.
• Conduct thorough code reviews, providing constructive feedback and ensuring adherence to best coding practices.
• Mentor and coach junior engineers, fostering a culture of continuous learning and technical excellence.
• Identify and implement improvements to the software development lifecycle, including automation, testing, and CI/CD pipelines.
• Troubleshoot and resolve production issues, working to ensure high availability and reliability of services.
• Evaluate and integrate new tools, frameworks, and technologies to improve development processes and team productivity.
• Drive the technical vision for projects, contributing to architectural discussions and long-term planning.

Senior Software Engineer

• Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff.
• Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria.
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff.
• Conducts regular audits, as assigned, to ensure guidelines are applied appropriately.
• In states where required, refers all cases that an approval cannot be rendered to the Physician Clinical Reviewer.
• In States where allowed, will make denial determinations as a specific case warrants.
• Converses with medical office staff in order to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale.
• Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plans required timeframes.
• Documents all communication with medical office staff and/or treating provider.
• Practices and maintains the principles of utilization management by adhering to policies and procedures.
• Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations.