Coordinator, UM Intake

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.

The Coordinator, Intake Utilization Management at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements.

The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization Management. In support of our daily operations, this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs, and Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Associate Director and Director may also be available.

Reviewing internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required.

Entering data into a proprietary system generates cases for both the medical and behavioral health reviewers. These requests may be submitted via fax, email, or provider portal.

Working directly with physician’s offices to obtain missing information required to submit a prior authorization request.

Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion.

Addressing requests promptly and courteously, honoring commitments, and displays persistence in obtaining necessary information to address issues and problems.

Meeting established Utilization Management Intake Objectives and Key Results.