Clinical Letter Writer PT Role -UM Experience Essential
Writer Job 2 miles from Guaynabo
**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:**
Our shared services team offers candidates the opportunity to make a meaningful impact by providing exceptional support to internal and external customers through positive interactions, and timely delivery of high-quality products. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes.
**Collaboration Opportunities:**
+ Works with the physician reviewer to monitor the adverse determination process and ensure notification timeframes are met
+ Works with internal and external staff to ensure that decisions are made, documented, and communicated clearly
**What You Will Be Doing:**
The Clinical Letter Writer is responsible for reviewing adverse determination decisions against criteria and policy, escalating questions to the physician reviewer, and creating letters that meet regulatory and Plain Language requirements. This position requires a person who can synthesize various clinical and administrative requirements, communicate well with the team and clients, and write clearly.
+ Reviews adverse determinations against criteria and medical policies
+ Creates adverse determination notifications that meet all accreditation, State, and Federal criteria
+ Uses Plain Language and good written skills to clearly communicate adverse decisions to both members and providers
+ Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director.
+ Appropriately identifies potential cases for Care Management programs
+ Communicates appropriate information to other staff members as necessary/required.
+ Participates in continuing education initiatives.
+ Collaborates with Claims, Quality Management and Provider Relations Departments as requested.
+ Performs other duties as assigned.
**Qualifications: Required and Preferred:**
+ Licensed registered nurse or LVN/LPN (current and unrestricted)
+ Minimum of three years of direct clinical patient care
+ **Minimum one year of experience with Utilization Review (UM) in a managed care environment**
+ Cardiology and Oncology Healthcare experience/knowledge
+ Excellent written communication skills
+ Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)
+ Strong interpersonal, oral, and written communication skills.
+ Possess basic Microsoft Office computer skills
+ Knowledge of managed care principles, HMO and Risk Contracting arrangements a **plus but not required**
**Please note this role is an average of 30 hours per week. The schedule includes 8-10 hours on Saturday, Sunday, holidays in addition to 1/2 days on Monday & Friday.**
**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 $31.00 to $34.00 per hour. 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!
Technical Writer (Network Infrastructure)
Writer Job 2 miles from Guaynabo
**Job ID Number** R4964 **Employment Type** Full time **Worksite Flexibility** Remote As a Technical Writer, you will be responsible for researching, organizing, writing, editing, and producing technical documentation. **Job Description** We are looking for a customer service-oriented **Technical Writer** to collaborate with the Senior Director of IT Network Infrastructure in creating compelling and informative content for vision and strategy presentations. This role requires a strong technical background, excellent communication skills, and the ability to translate complex Connectivity Technical concepts into clear, engaging materials. The focus will be on Enterprise Network Connectivity Services. This position will be **contract** and **remote** .
**What You'll Do**
+ Work closely with the Sr. Director of IT Network Connectivity services to understand Team accomplishment, objectives and messaging for C-Level presentations.
+ Develop high-quality content, including presentation slides, whitepapers, Success User stories, and technical summaries, tailored to the target audience.
+ Research and synthesize information on IT network infrastructure trends, innovations, and company-specific solutions.
+ Work closely with the leadership team to define, articulate, and present the team's vision and strategic roadmap for both short-term and long-term objective.
+ Articulating the vision and roadmap using language tailored for executive audiences.
+ Ensure all content aligns with the company's branding and communication standards.
+ Collaborate with cross-functional teams to gather input and validate technical accuracy.
+ Edit and proofread materials to ensure clarity, consistency, and professionalism.
+ Manage timelines and deliverables to meet deadlines.
**What You'll Need**
Required:
+ Bachelor's degree in Technical Writing, Communications, IT, or a related field (or equivalent experience).
+ Proven experience creating executive presentation short-term, long-term vision, preferably in IT Network Infrastructure domains.
+ Ability to create visually appealing and effective presentation materials using tools like PowerPoint, Canva, or Visio.
+ Strong research and analytical skills to gather, interpret, and present complex technical information.
+ Experience working with technical teams and executives to ensure alignment and accuracy of the content.
+ **Strong understanding of IT network infrastructure concepts, technologies, and trends focusing on WAN, LAN, Inbound connectivity, Outbound connectivity, Network Security, Datacenter and DDI.**
+ **Familiarity with IT network infrastructure tools, platforms, and technologies (e.g., network monitoring tools, cloud services, Azure DevOps or security protocols)**
+ Exceptional writing, editing, and communication skills.
+ Strong organizational skills to manage multiple projects and meet tight deadlines.
**Physical Demands**
+ Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state and local standards.
+ Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc.
+ Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard and monitor.
\#LI-AE1
**Reasonable Accommodation Statement**
If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to application.accommodations@cai.io or (888) 824 - 8111.
**Equal Employment Opportunity Policy Statement**
It is the policy of CAI not to discriminate against any employee or applicant due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. It is also the policy of CAI to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Employees and applicants of CAI will not be subject to harassment due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or being a protected veteran. Additionally, retaliation, including intimidation, threats, or coercion, because an employee or applicant has objected to discrimination, engaged or may engage in filing a complaint, assisted in a review, investigation, or hearing or have otherwise sought to obtain their legal rights under any Federal, State, or local EEO law is prohibited.