About the job Nurse (USRN) - Letter Writer Coordinator
Its 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 delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of Beckers 150 Great Places to Work in Healthcare in 2016 and 2017, and one of the 50 Great Places to Work in 2017 by Washingtonian, and our CEO was number one on Glassdoors 2015 Highest-Rated CEOs for Small and Medium Companies. 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:
- Review and assign incoming work to the Letter Writer team
- Collect, organize and track information received from a variety of resources to facilitate and expedite processing
- Works with the team to monitor the adverse determination process and ensure notification timeframes are met
- Creates adverse determinations notifications that meet all accreditation, State, and Federal criteria
- Uses Plain Language and good written skills to clearly communicate adverse decisions to both members and providers for non-medical adverse determinations
- Works with internal and external staff to ensure that decisions are made, documented and communicated clearly
- Communicates appropriate information to other staff members as necessary/required
- Utilize multiple internal and external computer applications and programs
- Meet established productivity and quality standards
- Performs other duties as assigned
The Experience You Need (Required):
- Two years experience within a health plan, managed care organization or third part administrator
- Understanding of appeals process and utilization management
- Strong interpersonal, oral and written communication skills.
- Computer proficiency in Microsoft Office
Finishing Touches (Preferred):
- We are looking for team members who possess enthusiasm, a strong work ethic, integrity, who are kind and empathetic, have a sense of humor, and who enjoy working in a collaborative, team-oriented system.
- Exceptional communication skills, both written and oral
- Strong work ethic built on a foundation of proactivity and teamwork
- Ability to navigate ambiguity with the aid of structured problem-solving techniques
- Experience with electronic health records
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.
Evolent Health is committed to the safety and wellbeing of all its employees, partners, and patients. 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.
As we continue to evaluate re-opening our offices more fully and begin to have specific roles that will require face to face interaction with our providers and patients in client facilities or homes, all employees must be prepared to meet our vaccine requirements with or without accommodation at that time.
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.