Associate Director, Clinical Rules Management

at Evolent in Augusta, Maine, United States

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 theyre supported to live their best lives, and when they feel welcome to bring their whole selves to work. Thats one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What Youll Be Doing:

Seeking a detail-oriented Clinical Rules Management, Associate Director 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.

+ Use exiting reports or help design new reports to help the team with identifying trends and design solution and prioritize implementations.

+ 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, Gene