REMOTE Full-Time Electrophysiology Clinical Reviewer - Nurse Practitioner or Physician Assistant

The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer.

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ESSENTIAL DUTIES AND RESPONSIBILITIES:? include the following. Other duties may be assigned.

• 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 Medial 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 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 Evolent 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.
• Performs other duties as assigned.

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QUALIFICATION REQUIREMENTS:? To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

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EDUCATION and/or EXPERIENCE:

Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized degree program OR a master’s degree from a program accredited the ARC-PA.

Minimum of five (5) years’ experience in the practice of EP cardiology (preferred) or primary care; knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred).

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LICENSE/CERTIFICATION:

Current, unrestricted state PA or RN/NP license in medicine or required specialty.

Of a PA, obtaining a passing score on a national certifying exam

Obtaining and maintaining required licenses in the states where NCH has business

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OTHER SKILLS and ABILITIES:

Strong clinical, management, communication, and organizational skills.

Demonstrated leadership skills

Analytic skills

Energetic and curious with a passion for quality and value in health care

Required to pass skills proficiency test

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.