Corporate VP, Utilization Management

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-62% in year-over-year revenue growth through 2015. Are we recognized? Definitely. We?re 12th on Forbes? list of America?s Most Promising Companies for 2015, one of ?Becker?s 150 Great Places to Work in Healthcare? in 2016, and our CEO was number one on Glassdoor?s 2015 Highest-Rated CEOs for Small and Medium Companies. 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:
Lead Evolent Health?s Corporate Utilization Management function working across Evolent?s various business units to create an integrated and efficient operation across medical and pharmacy utilization management functions, as well as adopting an integrated behavioral health approach. This includes Medicare Advantage, Commercial exchange, Commercial fully insured employer group, Commercial ASO and Medicaid populations.
Initially focus on generating greater efficiency and effectiveness in Evolent?s current Provider Sponsored Health Plan Utilization Management function, working in partnership with Evolent?s Project Management Office in a structure that integrates closely with Evolent?s IT department, compliance, internal audit and reportinganalytics.
Partner closely with Solution Clinical Operations and the Clinical Center of Excellence to insure that UM approaches are fully integrated with Care Management and other medical management interventions
Drive innovation and creativity into Evolent?s Utilization Management approach so that Evolent?s unique ability to partner closely with provider organization creates a less frictionless approach and reduces operating expenses for both Evolent and its partners, while driving necessary impact on medical costs and quality.
Partner with TPA and partners (e.g. UPMC) for functions that the TPAs operate across aspects of customer service appeals, disputes and claims functions to improve effectiveness.
Deploy a line of business specific approach that enables Evolent to deploy efficiently against Commercial, ASO, Medicare Advantage, SNP and Medicaid lines of business.
Migrate focus from Provider Sponsored Health Plan specifically to integrating Evolent?s other lines of business including operations in Valence legacy business and Passport (Louisville) legacy business. Deploy a firmwide UM approach that optimizes centralized controls, platform requirements, audit and oversight and policies and procedures with decentralized flexibility and accountability.
Develop and oversee an integrated approach to pharmacy, behavioral and medical UM approach in partnership with Evolent?s Pharmacy leadership team, and Evolent UM Medical Directors.
Oversee work with Evolent?s Behavioral Health Medical Leadership to create an integrated Behavioral and Physical Health UM model.
Interact with health system partners to communicate UM clinical, financial and regulatory effectiveness.
The Experience You Need (Required):
Required A Bachelor's Degree in a related field, with a requirement that the candidate to be a nurse or physician.
Preferred A Master's Degree in a related field
Required 10 years of experience in Utilization Management in management or leadership roles, preferably in a health plan organization.
Experience operating across Medicare Advantage, Commercial and Medicaid lines of business

Finishing Touches (Preferred):
Experience overseeing aspects of pharmacy utilization management andor Behavioral Health UM experience
Experience working in a Provider Sponsored Health Plan or Capitated Provider Organization
Experience with CMS audits and in working closely with internal auditcompliance functions
Experience operating in a LEAN or Six Sigma environment to build processes with low error rates and high levels of operational performance
Evolent Health is an Equal OpportunityAffirmative Action Employer c3598c4ba3e4427c9c28e285136d3fe8

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