Your Future Evolves Here

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.

What You’ll Be Doing:

The Client Services team offers candidates the opportunity to positively impact member’s care daily. Our clinical operations team possess a can-do spirit, as they will wear multiple hats throughout the day working through different scenarios to ensure members and providers receive decisions timely. We believe in creating opportunities for our staff to grow, so the candidate must be passionate about leading, coaching and motivating. We are a team of leaders who accomplish our mission through valuing people, providing resolutions, driving results, and collaborating with others.

Collaboration Opportunities:

• The Manager, Client Services oversees daily utilization management and directs the medical care of our members on behalf of our health plans and serves in a supporting role to the Director, Intake and Utilization Management Operations.

• This individual will not only lead a production team but will also work closely with our cardiology and oncology clinical teams on a regular basis. Opportunities to work collaboratively with other intake leaders across the organization, training and development, provider relations, member services, claims management and our implementation team will also be available.

What You Will Be Doing:

• Through daily monitoring, meets health plan baseline Service Level Agreements and Turnaround Timeframes related to inventory management. Addresses issues with the potential of missing an SLA or TAT timely.

• Responsible for monitoring utilization management resources, incoming provider requests, implementation of initiatives, and educational processes to achieve targeted utilization management results established at both the health plan and department level.

• Supports the daily needs of a production-based team which may include up to 25 Client Service Coordinators. Tasks typically include hiring, coaching, monitoring progress towards objectives and key results, etc.

• Responds to inquiries and escalations from our health plans, providers and internal leaders promptly providing next steps or resolutions.

• Responsible for directing activities related to special projects for utilization management and use of project resources.

Qualifications - Required

• RN Licenses (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. Experience in consulting or services organizations with a proven ability to manage client relationships and achieve change within another organization preferred.

• 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, and ability to quickly assess client practices.

• 2-4 years of Previous management experience or equivalent years of experience in a capacity of mentoring/ leading others.

• Experience for driving and achieving a high standard of quality utilization management and results.

Technical Requirements:

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 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. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $90 up to $110,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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For more insights about Evolent Health, click on Life At Evolent (https://www.evolent.com/) to learn more!