Evolent

Director

• Serve as a key member of the Client Value team, responsible for effective management of value-based contracts.
• Track and monitor overall financial performance, underlying trends in cost and utilization.
• Leverage data, client input, and strategic insights to develop client-specific performance plans.
• Coordinate projects and programs for delivering cost and quality results.
• Facilitate cross-functional teams across various departments.

Director, Client Value

• Manage voice of customer insight gathering through survey administration and customer specific primary research
• Facilitate internal forums to promote alignment and accountability across internal teams (e.g., SLA timelines, product performance and value, data monitoring / platform issues, etc.)
• Serve as the main customer point of contact for key initiatives with a focus on solutioning, streamlining processes and working cross-functionally to ensure timely execution
• Coordinate customer communication (payer and provider) on key initiatives, projects, or issues/incidents that impact service delivery
• Develop an “issue resolution” playbook, promoting consistent definitions of problem types and standardizing solutioning
• Ensure SLA’s are maintained via a central database, instilling best practices for monitoring and managing across the customer org
• Monitor internal issue ticketing system / reporting to ensure key customer issues are being addressed in a timely manner

Director – Service Excellence

• Lead the development of analytical capabilities and processes related to evaluating performance with our capitated risk partnerships including cost & use projections, financial reconciliations, and providing insight in utilization drivers.
• Act as a thought partner to Client & Product teams to outline strategic approach for current risk partnerships, various value-based care models, financial/quality-based metrics, and provide discovery and product design analytical support.
• Design and implement standardized, scalable analytical frameworks that enhance efficiency, consistency, and impact across internal teams and external partners.
• Analyze performance capitated risk partnerships, focusing on cost and use trends, and estimate Evolent’s ability to reduce costs and improve quality.
• Assist in the development of budgets and forecasts for each client and packaging key insights for tracking performance.
• Develop models to quantify and articulate value. Communicate actionable conclusions from analyses to executive internal/external audiences.
• Collaborating with internal/external business customers to understand their problems and objectives, solve business questions, and help them to achieve goals by performing statistical analysis, developing analytic models, creating data reports/dashboards using a variety of performance metrics.
• Partnering with other analytical, product and IT leaders in assessing new and existing analytical tools and continuously improving analytical processes.
• Leading and facilitating interactions with existing customers in a manner that fosters trust in Evolent’s expertise and a spirit of collaboration.

Associate Director, Performance Suite Analytics

• Key leader of the analytics partnership with Client & Product teams to outline strategic approach for current risk partnerships, various value-based care models, financial/quality based metrics, and provide discovery and product design analytical support.
• Serving as strategic owner of our analytics capabilities and processes related to evaluating performance with our capitated risk partnerships including cost & use projections, financial reconciliations, and providing insight in utilization drivers.
• Analyze performance capitated risk partnerships, focusing on cost and use trends, and estimate Evolent’s ability to reduce costs and improve quality.
• Assisting in the development of budgets and forecasts for each client and packaging key insights for tracking performance.
• Leading and facilitating interactions with existing customers in a manner that fosters trust in Evolent’s expertise and a spirit of collaboration.
• Collaborating with internal/external business customers to understand their problems and objectives, solve business questions, and help them to achieve goals by performing statistical analysis, developing analytic models, creating data reports/dashboards using a variety of performance metrics.
• Partnering with other analytical, product and IT leaders in assessing new and existing analytical tools and continuously improving analytical processes.
• Managing, mentoring, and coaching members of the team.
• Setting clear goals and objectives using metrics to measure performance while holding staff accountable.
• Develop models to quantify and articulate value.
• Communicate actionable conclusions from analyses to executive internal/external audiences.
• Extract, manage, and analyze claims and operational data using industry-standard metrics.

Director, Performance Suite Analytics

Analyst

• Utilize and develop analytic tools to solve complex business challenges and support decision making that can have a considerable impact on the organization and patient health
• Support the Medical Cost Management activities, working in a Medical Economics team that supports Business Development and new product efforts
• Support the underwriting of capitated risk proposals involving cost & use projections, trend selection/development, and estimation of Evolent’s ability to reduce cost and improve quality
• Support the design of financial arrangements that are equitable for both Evolent and our Partners
• Support the development of models and approaches aimed at quantifying and articulating our value
• Perform research and analysis of complex healthcare claims, eligibility, and pharmacy data to make recommendations based on relevant findings
• Draw actionable conclusions from analyses and effectively communicate to internal/external audiences at various levels of the enterprise
• Translate analyses into Customer-ready deliverables using available visualization tools
• Provide support and facilitate interaction with customers in a manner that fosters expertise and cooperation
• Process and validate raw unadjudicated claims data
• Use programming skills to explore, examine and interpret large volumes of data in various forms to complete deliverables with minimal assistance and oversight

Analyst, Performance Suite Analytics

• Lead a team focused on driving delivery excellence and transformation across the organization
• Report directly to the Chief Customer Officer
• Work cross-functionally to foster a "customer first" mindset
• Drive prioritization and escalation of initiatives with customer impact
• Execute on the issue response governance playbook & downstream communication
• Manage and oversee all Voice of Customer activities
• Collate information and data to communicate voice of customer insights
• Drive transformation of customer org process improvements

Managing Director, Service Excellence

Medical Director

• Serve as the Physician match reviewer in PM&R cases
• Discusses 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
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process
• Participates in on-going training per inter-rater reliability process

Field Medical Director, Physical Medicine

• The Managing Director, Strategic Accounts role is a dynamic, fast paced position, serving as the single executive accountable for client health, strategy, success, and growth
• Own a book of client specific P&Ls including retention, expansion, and operational efficiency
• Foster executive relationships at client accounts
• Lead a team of account directors and managers
• Act as a strategic advisor and consultative partner
• Help identify opportunities for more impactful management of health plan’s specialty care initiatives
• Manage the commercial process for these growth opportunities in collaboration with Business Development, Corporate Development and Operations leaders
• Develop and orchestrate market-specific and enterprise performance initiatives
• Cultivate productive, trusted relationships with key partner executives and stakeholders
• Own the strategy and execution of the commercial process for contract management, negotiation, and renewals

Managing Director, Strategic Accounts

Medical Reviewer

• 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.

Clinical Reviewer, Nurse Practitioner/Physician Assistant – Vascular Surgery

• Analyze healthcare utilization, authorization, and claims data to identify trends, cost drivers, and opportunities for improvement.
• Perform complex data analysis using SQL, PowerBI or Excel to support internal and external stakeholders.
• Develop and maintain reports, dashboards, and performance metrics using tools like SQL, PowerBI, and Excel.
• Automate and optimize recurring reports and ad-hoc analyses.
• Review and QA output, identify trends independently, and communicate key information to teams outside analytics.
• Partner with internal teams (e.g., Clinical Ops, Product, Finance) and external clients to gather requirements and deliver actionable insights.
• Create polished presentations and narratives that highlight key insights and recommendations.
• Identify opportunities to improve data reliability, reporting efficiency, and analytical methodologies.

Senior Analyst, Performance Analytics

• Functions in a clinical review capacity to evaluate all cases that do not pass the authorization approval process at first call
• 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
• Converses with medical office staff 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