Clinical Operations Manager

2 days ago


Atlanta, Georgia, United States Evolent Health Full time
About the Role

Evolent Health is seeking a highly skilled Clinical Operations Manager to join our team. As a key member of our Client Services team, you will be responsible for overseeing daily utilization management and directing the medical care of our members on behalf of our health plans.

Key Responsibilities
  • Monitor and meet health plan baseline Service Level Agreements and Turnaround Timeframes related to inventory management.
  • Address issues with the potential of missing an SLA or TAT in a timely manner.
  • Responsible for monitoring utilization management resources, incoming provider requests, implementation of initiatives, and educational processes to achieve targeted utilization management results.
  • Support the daily needs of a production-based team, including hiring, coaching, and monitoring progress towards objectives and key results.
  • Respond to inquiries and escalations from our health plans, providers, and internal leaders in a prompt and professional manner.
Requirements
  • RN License (Active and Unrestricted)
  • Associate's degree or equivalent years of work experience
  • 1-2 years of experience working with a global workforce and a working knowledge of clinical quality metrics such as HEDIS and NCQA preferred
  • 2 – 4 years of operations and Utilization Management experience in a population management or managed care/insurance or hospital medical management department setting may be substituted for associate degree
  • Sophisticated knowledge of clinical operations in managed care, including quality management, outcomes, provider network, claims, financial management, care management policies, disease state and population management, members' rights and responsibilities
What We Offer

Evolent Health offers a comprehensive benefits package, including health insurance benefits, to qualifying employees. The expected base salary/wage range for this position is $90,000 to $110,000, with a bonus component dependent on pre-defined performance factors.



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