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Evolent Health LVN, Appeals and Grievances in Topeka, Kansas

It’s 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? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our 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.

What You’ll Be Doing:

It’s 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 power that brings us to work each day. We believe in embracing new ideas, testing 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? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index, was named on the Best Companies for Women to Advance List 2020 by Parity.org, and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our 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.

What You’ll Be Doing:

  • Act as a member advocate addressing member or provider concerns

  • Evaluate, review and evaluate appeals and grievances in compliance with state, federal and other regulatory requirements

  • Research, investigate and summarize complex issues using state and federally mandated benefits, EOC/COC/SPD benefit language, CMS guidelines, Medical Policies and Interqual criteria

  • Prepare cases for Medical Director and/or External Review

  • Develop timely and professional documentation and correspondence that ensures accuracy, completeness and conformance to quality and regulatory standards

  • Formulate fortitude language that resolves member or provider issues in a manner consistent with regulatory and accrediting agency requirements

  • Recognize potential quality of care concerns

  • Utilize multiple internal and external computer applications and programs

  • Meet established productivity and quality standards

  • Quarterly travel for team events and trainings

The Experience You Need (Required):

  • Active, Unrestricted Licensed Practical Nurse License

  • Minimum of 2 years of appeals experience in a payer-based environment

  • Minimum of 5 years of acute care or outpatient clinical experience

  • Minimum of 3 years of utilization management experience in a payer-based environment

  • Excellent written and oral communication skills

  • Proficiency with PC-based software programs including Word, Excel and Outlook

  • Strong critical thinking, analytical, research and organizational skills

  • Ability to work remotely and objectively

  • Access to high speed broadband or DSL internet in a secure home office

Finishing Touches (Preferred):

  • BS Degree

  • Expertise in Medicare appeals

  • Medical coding experience

  • Medical claims review experience

Technical requirements:

During the current pandemic Evolent employees are working remotely from home. 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 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.

#LI-Remote

Technical requirements:

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 and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. 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. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

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 typical range of employees within the compensation grade of this position is . Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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