Medical Reviewer

• 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.

Clinical Reviewer for Radiation Therapy advocating for members' care and cost-effectiveness

Clinical Reviewer, Radiation Therapy

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.

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Clinical Reviewer, Radiation Therapy