Oncology Clinical Reviewer - Nurse Practitioner/...

Your Future Evolves Here Evolent partners with health plans and providers to enhance outcomes for those facing complex and costly health conditions. By bridging gaps across specialties and primary care, we ensure individuals receive the care and compassion we would want for our loved ones. At Evolent, employees enjoy a healthy work-life balance, flexibility in tailoring their work to fit their lives, and the autonomy needed to excel. We believe that individuals perform their best when supported to lead fulfilling lives and feel encouraged to bring their authentic selves to work. This commitment to diversity and inclusion lies at the core of our business. Join us for the mission, and stay for the engaging culture! What You'll Be Doing: As an Oncology Nurse Practitioner/Physician Assistant, you will play a vital role in supporting all administrative and clinical utilization management and quality improvement functions under the guidance of the Chief Medical Officer’s office. ESSENTIAL DUTIES AND RESPONSIBILITIES: Perform initial clinical reviews of incoming cases, rendering authorization decisions based on established clinical criteria, or refer to a Field Medical Director if initial approval is not possible. Act as a clinical liaison to providers, clients, and patients as directed by the Chief Medical Officer’s office. Engage in clinical discussions with providers and office staff regarding medical necessity determinations. Maintain and operate Guideline Directed Treatment plans, communicating with offices about treatment recommendations. Request additional clinical information from ordering providers when necessary. Prepare cases for peer-to-peer conversations with oncologists for those which cannot be approved or modified by providers. Coordinate with UM staff to ensure timely and accurate communication regarding clinical decisions. Assist in UM projects and participate in site visit reviews. Adhere to HIPAA confidentiality guidelines. Be available to clinical and non-clinical staff during the initial and second-level screening process. Serve as a liaison between various departments, offices, and committees. Act as a subject matter expert and engage in meetings with practices and/or payers as needed. Collaborate with the Director of Clinical Operations to ensure high client satisfaction. Perform all peer clinical review activities while located within a state or territory of the United States. Uphold honor and integrity, serving as a role model for the company. Undertake other duties as assigned. QUALIFICATION REQUIREMENTS: To succeed in this role, candidates must be able to perform each essential duty satisfactorily. The following qualifications are necessary: Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from an accredited program OR a master's degree from an ARC-PA accredited program. Three (3) to five (5) years of experience in Oncology practice (required). Knowledge of regulatory standards, preferably with at least two years of experience in a regulatory role (preferred). LICENSE/CERTIFICATION: Current, unrestricted state PA or RN/NP license in medicine or the required specialty. If a PA, a passing score on a national certifying exam is required. Must obtain and maintain the necessary licenses, as per business needs. A clinical license, active and in good standing, in your home state is mandatory. OTHER SKILLS and ABILITIES: Exceptional clinical, management, communication, and organizational skills. Proven leadership abilities. Strong analytical skills. Energetic and inquisitive, with a genuine passion for quality and value in healthcare. Must pass a skills proficiency test. To ensure a secure hiring process, we have implemented various identity verification steps, including submission of a government-issued photo ID. Identity verification will be conducted during interviews, and final interviews may require on-site attendance. All candidates must undergo a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is closely monitored and prohibited. Misrepresentation will lead to immediate disqualification from consideration. Technical Requirements: All employees are expected to have the following technical capabilities at home: High-speed internet over 10 Mbps and, specifically for call center employees, the ability to connect directly to the home internet router. These requirements may change with any scheduled reopening of our office locations. Evolent is an equal opportunity employer and considers all qualified applicants 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 for this position is $68-$73 per hour. This role also includes an eligible bonus component based on predefined performance criteria. Evolent is proud to offer a comprehensive benefits package (including health insurance benefits) to qualifying employees. Compensation determinations are based on the skills and experience required for the position and commensurate with the selected individual’s experience, which may vary above and below the stated amounts. If you don't see your dream job here, feel free to submit your contact information and resume, and we will reach out if we find the perfect fit!

Created: 2026-03-10