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Evolent Health Behavioral Health, Utilization Management in Boston, Massachusetts

It’s Time For A Change… Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018 . Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and One of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Hours:

9:00am-6:00pm Central

What You’ll Be Doing:

  • Performs precertification, prior approvals, and monitoring activities for mental health and substance abuse problems

  • Acts as a member advocate by expediting the care process through the continuum, working in concert with the health care delivery team to maintain high quality and cost-effective care delivery.

  • Determines medical necessity and appropriateness of services using clinical review criteria based information given by providers.

  • Accurately documents all review determinations and contacts providers and members according to established timeframes.

  • Identifies and refers cases that do not meet established clinical criteria to the Medical Director.

  • Identifies and refers quality issues to the Director of Medical Management or Medical Director.

  • Identifies potential cases for Care Management programs.

  • Performs accurate data entry in order to meet quality goals.

  • Communicates information to other staff members as necessary/required.

  • Participates in continuing education initiatives.

  • Collaborates with Claims, Quality Management and Provider Relations Departments as requested.

  • Other duties as assigned.

The Experience You Need (Required):

  • Actively independently licensed in (LCSW, LCPC, RN

  • Master’s degree in Behavioral Health or RN

  • Minimum of three years of direct clinical patient care

  • Minimum of one year of experience with medical management activities in a managed care environment

Finishing Touches (Preferred):

  • We are looking for team members who possess enthusiasm, a strong work ethic, integrity, who are kind and empathetic, have a sense of humor, and who enjoy working in a collaborative, team-oriented system.

  • Knowledge of managed care principles, HMO and Risk Contracting arrangements.

  • Knowledge of health care resources within the community

  • Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)

  • Strong interpersonal, oral and written communication skills.

  • Possess basic computer skills

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners, and patients. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.

As we continue to evaluate re-opening our offices more fully and begin to have specific roles that will require face to face interaction with our providers and patients in client facilities or homes, all employees must be prepared to meet our vaccine requirements with or without accommodation at that time.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. Evolent Health maintains a drug-free workplace.

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

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