UR Nurse
Company: Evolent Health
Location: Baton Rouge
Posted on: August 3, 2022
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Job Description:
This is an unique opportunity to improve the health and
wellbeing of millions of Americans! Founded in 2002, New Century
Health has been on the cutting edge of value-based innovation for
decades as the nation's foremost specialty care management company,
specializing in managing cancer and cardiology patients for both
payers and risk-based providers. Formerly backed by Water Street
Partners, the company was acquired by Evolent Health in 2018 and
has scaled tremendously since.Specifically, New Century Health
provides physicians with clinical decision and population health
management tools to ensure that their patients receive the highest
quality, most affordable care. These best-in-class tools, which
have earned the business URAC accreditation in Health Utilization
Management and NCQA accreditation in Utilization Management,
consistently drive clinical and financial improvements for the two
most complex and expensive diseases in the nation. This commitment
to excellence has helped spur our success and put us on track to
surpass record-breaking year-over-year growth in the coming years.
It's Time For A Change... Your Future Evolves Here At New Century
Health we are pioneering a new era of specialty care, focused on
engaging with payers and providers to improve the quality of care
for patients diagnosed with cancer and heart disease. Our
evidence-based care delivery model supports patients during their
most vulnerable times, a responsibility we are both humbled by and
passionate about.With nearly two decades of proven results in
Oncology and Cardiovascular care, New Century Health improves
quality and lowers costs for the 6M+ patients whose care we manage.
Our approach is based on a proven clinical model that engages
Oncology and Cardiovascular specialists through value-based care
delivery. We believe the highest quality care is also the lowest
cost care over time, improving outcomes and delivering financial
savings to our partners. The New Century Health model has been
proven across Medicare, Medicaid, and Commercial populations. New
Century Health joined the Evolent Health family in 2018, joining
the mission to change the health of the nation.Are we growing?
Absolutely. We have seen about 30% average growth over the last
three years. Are we recognized? Definitely. We 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 workplace. 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. What You'll Be Doing: + Reviews Provider request for relevant
and complete supporting documentation.+ Requests additional
documentation per New Century Health (NCH) policy.+ Utilizing
clinical guidelines approved by NCH 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.+ Ensures regulatory guidelines are met for
timeliness and use of medical review criteria.+ Verifies accuracy
of codes and services and applies them accurately with appropriate
documentation.+ Establishes and maintains professional
relationships with Providers and office staff for the purpose of
education to establish a smooth operational flow of authorizations
and referrals.+ Educates and supports UM staff with medication
requests, laboratory results and documentation of submissions per
approved NCH policy guidelines.+ Complies with current URAC
standards as they relate to this position.+ Supports clinical
initiatives as identified by the UM department and UMC.+ Assists
Chief Medical Officer (CMO), Medical Reviewers and the Clinical
Specialist in the submission of developed and approved pathways
sent to Information Technology.+ Assists the Director of UM,
Medical Reviewers and CMO to develop report data elements necessary
to track and trend utilization practices by provider, practice
variation reports, reports to support quality initiatives, and
elements to support NCH dashboard reports.+ Acts with honor and
integrity, serving as a role model for the company.+ Complies with
HIPAA requirements and all NCH policies and procedures.+ Acts as an
interdepartmental liaison between all NCH offices, departments, and
committees.+ Performs other duties as assigned. The Experience
You'll Need (required) :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.+ Possesses effective
verbal/written communication skills, especially via phone, with the
ability to interact with various levels of personnel.+ Able to work
in a fast-paced environment, demonstrate excellent problem solving,
critical thinking, and organizational skills.+ Performs multiple
tasks efficiently and accurately, have exceptional attention to
detail and perform consistent work product validation/QA.+
Self-motivated, self-directed, team oriented, and responsible, with
a positive attitude and a proactive style. Possesses the ability to
operate in a highly variable work environment.+ Presents a
courteous and competent demeanor to our clients and teammates.+
Bachelor's degree in Nursing or HealthCare related field preferred.
Unrestricted Registered Nurse (RN), LPN or LVN license required for
the state of employment.+ Excellent customer service skills+ Strong
computer skills in MS Excel and Word.+ Ability to easily navigate
through website research.+ Ability to work nights and weekends, as
necessary. Finishing Touches (preferred): + 2 - 4 years UM
experience preferred.+ 2 - 3 years in an inpatient or outpatient
setting highly preferred.+ Specialty certification preferred.+
Ability to review medical records and identify codes for claims
processing preferred.+ Oncology and/or cardiology experience highly
preferred. Evolent Health is an equal opportunity employer and
considers all qualified applicants equally without regard to race,
color, religion, sex, sexual orientation, gender identity, or
national origin. 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. Technical requirements: Evolent allows employees to work
remotely for many of our positions. For those working remotely, 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.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. Evolent Health
maintains a drug-free workplace. Evolent has been 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 workplace. 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..... click apply for full job details
Keywords: Evolent Health, Baton Rouge , UR Nurse, Healthcare , Baton Rouge, Louisiana
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