Human Resources Assistant
Jafferjee Brothers Exports (Pvt) Ltd
Job type full-time
Full job description
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 deliveredOur pursuit of this mission is the driving power that brings us to work each dayWe believe in embracing new ideas, testing ourselves and failing forwardWe respect and celebrate individual talents and team winsWe have fun while working hard and evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? absolutelyWe have seen about 30% average growth over the last three yearsAre we recognized? definitelyWe were named one of “becker’s 150 great places to work in healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important diversity and inclusion (d&i) efforts: evolent achieved a 95% score on its first-ever submission to the human rights campaign's corporate equality index, was named on the best companies for women to advance list 2020 by parity.org, and we publish an annual diversity and inclusion annual report to share our progress on how we’re building an equitable workplaceWe recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each dayIf you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a missionJoin a mission with a company behind it.
The nurse reviewer is responsible for performing precertification, prior approvals, concurrent and retrospective reviews, and coordination of discharge planningTasks are performed within the rn scope of practice, under medical director direction, using self-directed nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria setsActs 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.
Essential functions all levels:
Performs utilization review of inpatient admissions, outpatient surgeries, and ancillary services.
Concludes medical necessity and appropriateness of services using clinical review criteria.
Accurately documents all review determinations and contacts providers and members according to established timeframes.
Appropriately identifies and refers cases that do not meet established clinical criteria to the medical director.
Appropriately identifies and refers quality issues to the senior director of medical management or medical director.
Appropriately identifies potential cases for care management programs
Partners with physicians and other providers to facilitate provision of services throughout the health care continuum.
Performs accurate data entry.
Conveys appropriate information to other staff members as necessary/required
Participates in continuing education initiatives.
Works with with claims, quality management and provider relations departments as requested.
Performs other duties as assigned.
Level 2 additional functions:
Functions as the key contact and utilization management expert for a client, business line, or product.
Duties may include clinical and operational meeting attendance, day-to-day oversight of work streams, and reporting analysis and action development
The experience you’ll need (required):
Licensed registered nurse (current and unrestricted)
Associate or bachelor degree in nursing required; bachelor degree preferred
Minimum of three years of direct clinical patient care
Minimum of one year of experience with medical management activities in a managed care environment, medicaid managed care preferred
Knowledge of managed care standards, hmo and risk contracting arrangements.
Knowledge of health care resources within the community
Experience with clinical decision-making criteria sets (i.eMilliman, interqual)
Strong interactive, oral and written communication skills.
Possess basic computer skills
During the current pandemic evolent employees are working remotely from homeAs 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 routerThese at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
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.