Clinical Letter Writer - UM

New

Skills

Healthcare Microsoft Office Oncology Regulatory Compliance

Job Overview

Evolent, a healthcare company focused on improving care outcomes, is seeking a Clinical Letter Writer with UM and specialty experience. The ideal candidate will play a key role in reviewing adverse determinations, creating letters meeting regulatory requirements, and communicating with various departments to ensure quality care.

Responsibilities
  • Review adverse determination decisions against criteria and policy
  • Escalate questions to the physician reviewer
  • Create letters meeting regulatory and Plain Language requirements
  • Identify and refer quality issues to senior management
  • Participate in continuing education initiatives
Requirements & Qualifications
  • Licensed registered nurse or LVN/LPN
  • Minimum 3 years of direct clinical patient care
  • Minimum 1 year of UM experience in a managed care environment
  • Cardiology and Oncology healthcare experience/knowledge
  • Strong written communication skills
  • Experience with clinical decision-making criteria sets
  • Basic Microsoft Office skills
  • Knowledge of managed care principles a plus

No forms. Your profile is generated instantly.

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: 12 Months

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