Medical/UM Clinical Guideline Writer

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.

Put your passion where it meets purpose! We are looking for a Medical/UM Clinical Guideline Writer who will be responsible for the development, approval, and maintenance of Utilization Management process documents to ensure compliance with legislative and accreditation requirements. This person will need to adhere to procedures, designated roles and responsibilities as outlined in the National Utilization Program Description.

Support and Development

• Research, write, and edit UM Clinical Guidelines, through lifecycle of guideline.
• Collaborate with Clinical Subject Matter Experts to ensure accurate and evidence-based clinical content in Clinical Guidelines.
• Update clinical process documents as needed to ensure they meet the minimum standards for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Company Policy across product lines and business segments.
• Tasked with problem solving and negotiation with internal and external customers around complex concepts and competing interests for risk mitigation.
• Research and incorporate customer and state regulatory requirements into Clinical Guidelines.
• Collaborate with multiple internal and external Key Stakeholders on the impact of Clinical Guideline changes.
• Oversee Clinical Guideline Committee, schedule and facilitate committee meetings, document meeting minutes, store all meeting content.
• Support the Medical Policy team on other projects and tasks.

Qualifications – Required and Preferred

• Bachelor's degree preferred but consideration for 4 or more years' experience medical writing will be considered OR Master’s Degree, PhD.
• Medical research and/or medical writing experience.
• Preferred healthcare experience (2+ years).
• Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product
• Analytical/problem solving skills.
• Strong interpersonal, consultation, organizational, tracking and follow-up skills.
• Possesses excellent verbal and written communication skills.
• Ability to work collaboratively with a team and with other Key Stakeholders.
• Ability to work independently with flexibility, and with ownership of assigned tasks.
• Preferred knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Centers for Medicare and Medicaid Services (CMS)].