1,589 Clinical Management jobs in the United States

Cross Country is looking for top talent to join our team! Cross Country is a market-leading, tech-enabled workforce solutions and advisory firm with more than four decades of industry experience and insight helping clients tackle complex labor-related challenges. Diversity, equality, and inclusion are at the heart of the organization's overall corporate social responsibility program as t is closely aligned with our core values to create a better future for its people, communities, and stockholders. Most recently named one of the 'Top Places to Work' by US News and World Report, and a Most Loved Workplace by Newsweek Magazine, Cross Country is committed to excellence in delivery of its services and was the first public company to earn The Joint Commission Gold Seal of Approval for Health Care Staffing Services Certification with Distinction.

BASIC PURPOSE
The Clinical Regional Vice President of Program Management (CRVP PM) will be dedicated to, and responsible for the clinical oversight and management of a Premium, Enterprise Managed Service Partnership. The purpose of this position is to ensure service delivery, client satisfaction and successful placements through the provision of clinical and professional knowledge and support to healthcare professionals, client contacts and internal team members.

The CRVP PM will be responsible for the direct oversight and management of the Strategic accounts/facilities in assigned region. They will grow the baseline business and introduce new revenue streams; where and when possible. This is a combined Clinical, Operational and Sales role, and as such has quotas established per account (rolled up to an overall portfolio). The CRVP PM must be able to manage to a P&L, assist with forecasting, budgeting, management of quality metrics, and sales growth. Client and Supplier satisfaction are key indicators of performance.

The Clinical Regional Vice President of Program Management will work in close collaboration with the workforce solutions operations teams, clinical services, suppliers, and client facilities to ensure that all components of our services are delivered and managed for continuous performance improvement. They will develop and cultivate system-wide relationships with key facility stakeholders, from the Staffing Office to the C-Suite, to ensure excellent service delivery and customer satisfaction with services provided.
Additionally, the CRVP of Program Management will lead and be accountable for oversight of onsite and/or regional team members serving aligned facilities.

ESSENTIAL FUNCTIONS
The following functions describe the essential duties of this role. Individuals in this role may not perform all of these duties, or may perform additional, related duties not listed here.
* Serve as the clinical leader for our Premium Enterprise Managed Service clients on service delivery
and issues related to MSP operations and management
* Provides all healthcare professionals (HCP) with clinical and professional support during assignments to facilitate assignment completion and professionals' retention
* Uses in-depth clinical knowledge, professional judgment, and good business-based decision-making skills to justify HCP terminations within a legal and ethical framework
* Develops remediation plan with HCP / Client HCF as appropriate to continue/enhance employment
* Follows-up with HCP and facility client on all performance evaluations that do not meet clinical standards or have negative clinical comments
* Partners with aligned Clinical Manager to ensure documentation is maintained and support process of Regulatory Reporting as necessary
* Refers to potential risk management incidents/issues as needed
* Provides recruitment and supply teams with guidance in making initial employment decisions when candidates do not meet the standard criteria for acceptance
* Provides the in-house employees with ongoing clinical and professional education based on the identified needs of Partnership facilities
* Participates in professionals' onsite orientation and onboarding
* Communicate and negotiate with internal and external clients
* Interacts in a professional and knowledgeable manner during conflict resolution with professionals and client to facilitate development of a win-win plan
* Works with Program Management team plan, develop and develop QBR's and QI initiatives
* Acts as resource to professionals to meet cognitive testing requirements of facility, to include on-line testing and remediation practices
* Develop relationships within facilities / organizations to assess and manage client needs. Evaluates, coordinates and reports activities to organizational leaders. Actively seek to diversify relationships within the client structure.
* Fosters an environment focused on client satisfaction, through implementation of best practices and measurement of performance and service delivery.
* Continually expand knowledge of healthcare staffing and workforce solutions market trends, industry analyst updates, and competitive data by reviewing internal and external sources (journals, articles, interactions with clients, etc.) in order to more effectively serve the client as a trusted advisor and consult on CCH services.
* Manages regional & onsite team dedicated to facilities. Coaches, mentors, and develops team goals and monitor performance against goals.
* Collaborate with key facility stakeholders; Supply Chain, Human Resource to negotiate terms of contract and resolve issues related to terms & conditions and bill rates.
* Develop a thorough understanding of the client's current and historical temporary staffing needs, key issues/challenges, and decision criteria and recommend CCH solutions to solve & address.
* Actively engage in CCH cross-selling efforts by identifying viable revenue source referrals and communicating with all business divisions to increase client touch points and grow market share.
* Participates in development and management of appropriate tools to evaluate and track customer satisfaction. Leverages quality of services through review of performance assessments and client satisfaction surveys. Monitors, analyzes, and reports client satisfaction results, and trending.
* Develop and champion customized solution addressing financial, operational and workforce planning challenges and align solutions with desired outcomes.
* Acts as liaison between facility and internal stakeholders to clarify and modify work processes and staffing practices across the organization. Acts a resource related to services, process, and technology.
* Ensures generation and distribution of utilization, activity, financial, key performance metrics, and service level agreement reports on a weekly, monthly, quarterly, or annual basis. Meets with key stakeholders to review.
* Works closely and in conjunction with internal teams to add services and modify solutions.
* Proactively identify challenges, effectively propose strategies, and execute solutions to respond to client.
* Conduct on-site visits and relationship building at all facilities, frequent travel required.
* Coordinate and deliver quarterly and annual business review presentations at every level of organization, from facility to system level.
* Collaborate with Marketing and Client to develop marketing materials, case studies, White Papers, and present partnership regionally and nationally.
* Responsible for reporting and distribution of site visit activities to CCS Executive Sponsors and Workforce Solutions teams providing actionable information.

Must have the ability to perform the essential functions of the job with or without reasonable accommodation.

QUALIFICATIONS
* Acute care hospital leadership experience required; Minimum 5 years Clinical / Human Resource Leadership.
* Licensed Registered Nurse strongly preferred.
* Bachelor's degree, MBA, or equivalent experience.
* Workforce Solution experience strongly preferred.
* Minimum 10 years' management and operations experience leading department of 5+ employees.
* Outgoing personality with ability to listen effectively.
* Ability to manage financial information: P&L, sales forecasting, and other key financial data.
* Ability to understand and evaluate clinical setting, staffing industry standards and client needs.
* Demonstrated exceptional communication and customer service skills.
* Work independently but also has a strong commitment to being a team player.
* Demonstrated analytical sense with excellent attention to detail.
* Results oriented.
* Ability to educate, inspire and motivate employees towards achieving divisional/company goals.
* Ability to negotiate.
* Adept at influencing individuals and bring meaningful change to the organization.
* Ability to handle multiple tasks and thrive in a fast-paced, high-pressure environment.
* Ability to communicate and work in a harmonious, respectful, supportive manner with all internal & external clients.
* Exceptional verbal and written communications skills to effectively convey a compelling value proposition, to gain support and build credibility. Proficiency in Microsoft Word, Excel, and PowerPoint
* Must maintain a high level of confidentiality.
* Team builder - communicate and work in a respectful, supportive manner with all team members.
* Ability to work in a fast paced, highly competitive, changing industry while maintaining customer focus.
* Must be able to prioritize demands.
* Must travel extensively within assigned region (Estimated 50% travel).

Company equipment(laptop, monitor, keyboard, mouse headset) will be provided directly to you for use during employment.

Benefits

Cross Country offers a competitive compensation, benefits, and wellness program, including Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Disability Insurance, Voluntary Insurance, 401(k) plan, Tuition Assistance, and Pet Insurance. The company offers a variety of Wellness options through Burnalong, which offers a robust online platform of classes and programs as well as local gym access.

Cross Country is an Equal Opportunity Employer (EOE) - Veteran/Disability

#IND123

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!

**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:**
**Clinical Rules Management, Analyst**
Seeking a detail-oriented **Clinical Rules Management, Analyst** who will play a critical role in ensuring the accuracy and integrity of our clinical rule engine, impacting our clinical review and recommendations for thousands of patients every day. This role will be responsible for the design, implementation, support, and maintenance of our clinical rules management systems. The ideal candidate will have a strong understanding of healthcare data and systems, with the ability to analyze and interpret complex clinical pathways to improve patient care.
**What You Will Be Doing:**
+ Collaborate with clinical staff to develop and implement systems that improve patient outcomes and enable efficient use of resources.
+ Assist with troubleshooting and problem resolution within the clinical information systems.
+ Conduct regular system audits to ensure the accuracy and quality of data.
+ Lead the evaluation of clinical processes in collaboration with other clinical corporate, division, and facility teams to facilitate process redesign and guide application of technology to ensure adoption, satisfaction, and compliance with policies and reporting requirements.
+ Proactively monitor updates to ICD-10/CPT/HCPCS codes, notify stakeholders of any changes, and ensure the system is updated on a timely basis, along with identifying its impact on clinical rules and implementing changes.
+ Support new client implementations.
+ Improve existing rule triggers for all specialties, including RBM, Physical Medicine, Genetic Testing, Pain Medicine, Sleep Study, Radiation Oncology, Cardiology, and any new specialty taken on by the organization.
+ Development and delivery of application training to end clients.
**Qualifications - Required and Preferred:**
+ Bachelor's/associate's degree plus a minimum of 5 years' relevant work experience
+ Good understanding of specialty benefit management business
+ Project management skills to keep up with multiple time sensitive tasks and projects
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, Teams)
+ Team player, critical thinker with excellent interpersonal skills
+ Knowledge of ICD-10 and CPT coding assignments for billing in an outpatient or physician office setting
+ Understanding of various lines of businesses in healthcare industry - Medicare, Medicaid, Commercial and Exchange plans
+ Strong adaptability and capacity to work in fast-paced environments
+ Effective written and verbal communication skills
+ Familiarity with CaseLogix or any clinical rules management system- **Not required but strongly preferred.**
+ Logical skills and familiarity with MS-Visio and convert them to an excel format for building the Q&A in the system- **Not required but strongly preferred.**
+ Clinical knowledge or previous experience in a medical environment- **Not required but strongly preferred.**
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**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** ** ** **for further assistance.**
The expected base salary/wage range for this position is $75,000 to $80,000. 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.
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!