Senior Policy Specialist

Your Future Evolves HereNew Century Health (NCH) has been transforming the delivery of specialty care and driving radical cost and quality improvement across the member journey for patients with cancer and cardiovascular disease. As part of Evolent Health, we are on a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their 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.Why We’re Worth the Application:

We continue to grow year over year.

Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .

Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index recognizing us as a best place to work for LGBTQ+ equality.

Named to Parity.org’s list of the best companies for women to advance for 3 years in a row (https://www.evolenthealth.com/about-us/press-releases/9328/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2022) (2020, 2021 and 2022).

Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.

Publish an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we’re building an equitable workplace.

What You’ll Be Doing:Job Summary:Responsible for the development, approval, and maintenance of Utilization Management process documents to ensure compliance with legislative and accreditation requirements. Adheres to procedures, designated roles and responsibilities as outlined in the National Utilization Program Description.Essential Functions:

Develops and customizes UM Process documents (Standard Operating Procedures (SOPs), Job Aids (JAs)) according to utilization management.

Provides oversight of the use of appropriate process documents and review requests for new or modifications to existing document templates

Reviews clinical policy submissions under our UM licensure submissions

Updates clinical process documents as needed to ensure they meet the minimum standards for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS), and Company Policy across product lines and business segments

Tasked with problem solving and negotiation with internal and external customers around complex concepts and competing interests for risk mitigation and avoidance of Corrective Action Plans.

Researches state regulatory requirements for clinical policies using online technology and research tools

Assists in facilitation of cross-departmental review process of policy/provider manual

Assists in cross-departmental development and production of policy/protocol material

Provides technical support and assistance to staff and departments in creation and writing of policy

Works cooperatively with Training Department to develop and deliver policy-related training for staff and providers.

The Experience You’ll Need (Required):

Healthcare 2+ years

Bachelors degree

2 years of experience with authorization correspondence, ensuring compliance with state/federal contractual requirements

Bachelor degree preferred but consideration for 4 or more additional years of experience will be considered

Analytical/problem solving skills

Strong interpersonal, consultation, organizational, tracking and follow-up skills

Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product

Possesses excellent verbal and written communication skills

Knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS)

Finishing Touches (Preferred):

Medical writing experience

Technical Requirements:We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, 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 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.Compensation Range: The minimum salary for this position is $80000, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!For more insights about Evolent Health, click on Life At Evolent (https://www.evolenthealth.com/about-us/life-at-evolent) to learn more!