Evolent

• Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. • Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. • Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. • Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. • Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. • Documents all communication with medical office staff and/or treating provider. • Practices and maintains the principles of utilization management by adhering to policies and procedures. • Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately.

• Develop and execute the strategic vision for Client Data Engineering, aligning technical investments and delivery priorities with business goals, client commitments, and product strategy • Lead the engineering teams responsible for client data ingestion, outbound data delivery, interface development, implementation support, and production support across provider, member, authorization, claims, and related client data domains • Partner closely with Product leadership to refine business and client requirements, improve requirement quality, and ensure engineering teams receive clear, actionable, and appropriately scoped work • Work directly with clients, implementation teams, and internal stakeholders to clarify technical requirements, identify risks and dependencies early, and scope client support requests so implementations happen on time and client satisfaction remains high • Drive successful client implementations by improving data readiness, validation practices, delivery predictability, and coordination across engineering, product, implementation, and operations teams • Establish clear ownership, operating models, and engagement patterns for Client Data Engineering teams so internal partners know how to engage the organization effectively and critical work is routed to the right teams • Lead the modernization of client data exchange capabilities, including migration of legacy interfaces and EDI-related workflows to more standardized, maintainable, and scalable platforms and patterns • Provide strategic direction for healthcare data integration capabilities, including EDI/X12 transactions, client-specific file interfaces, data movement across operational platforms, and evolving interoperability approaches such as FHIR-enabled architectures where appropriate • Ensure strong governance of software engineering and data engineering practices across the organization, including design, testing, release management, production readiness, support processes, and operational accountability • Monitor and improve delivery, quality, and operational performance through the use of metrics, service health indicators, implementation outcomes, and continuous improvement practices • Build strong cross-functional relationships with Product, Client Delivery, Implementation, Operations, Architecture, Infrastructure, and other Engineering teams to resolve issues quickly and deliver value-driven solutions • Lead and mentor directors, senior directors, managers, and technical leaders within Client Data Engineering, building a culture of accountability, collaboration, technical excellence, and customer focus • Drive organizational planning, staffing, and talent development for a geographically distributed team, including contractor and vendor strategy where needed to support business priorities • Represent Client Data Engineering in executive discussions and broader organizational planning, communicating priorities, risks, dependencies, progress, and strategic recommendations effectively.

• Currently seeking Family Medicine Physicians to join our Radiology department. • Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals. • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. • Aids and acts as a resource to Initial Clinical Reviewers. • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. • Participates in on-going training per inter-rater reliability process.

Role Description The Performance Suite Analytics team offers candidates the opportunity to generate meaningful impact through translating disparate data points into tangible insights and actions. Our team values accuracy, collaboration, and innovation, ensuring that all team members receive the support, tools, and skills to positively contribute to Evolent’s broader mission. The Senior Analyst, Performance Suite Analytics utilizes and develops analytic tools to solve complex business challenges as well as support decision making that can have a considerable impact on the organization and patient health. This role supports both Medical Cost Management activities as well as Business Development efforts, working in a Medical Economics team that supports Business Development and new product efforts. - Support the clean data transfer between Evolent and its customers in the Performance Suite where Evolent does not pay claims. - Support the design of data transfer protocols during client onboarding and implementation, and refinement efforts on an ongoing basis. - Develop models to evaluate data quality on a regular basis to uncover irregularities in data submitted from clients and work cross-functionally to identify the root cause. - Apply post-pay audit and payment integrity methods and techniques to ensure claims were paid according to policy. - Coordinate with internal teams to ensure clean and consistent tracking of Evolent’s covered membership and claims. - Support the design of standardized processes, templates, and collateral for key client-facing financial activities. - Create models to assist in financial scope reconciliation efforts. - Identify potential risks and opportunities related to partner data, enabling leadership to better resource solutions, negotiate contractual terms, or settlements. - Perform ad hoc client-specific analyses to support strategic decision-making. Qualifications - Bachelor’s degree, preferably with a quantitative major (e.g. actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health administration, epidemiology, public health, biology). - 1-3 years of professional experience in claims-based healthcare analytics with a payer, provider, clinical vendor, managed care, or related healthcare consulting entity. - Ability to communicate clearly with diverse stakeholders to solve problems; ability to translate between business needs and analytical needs. - Exceptionally strong analytical abilities, with track record of identifying and communicating insights from quantitative and qualitative data. - Advanced or higher proficiency in SQL or SAS database/statistical programming languages and Microsoft Excel. - Experience using data visualization software (e.g. Power BI, Tableau, or similar) to package analytical insights. - Experience in data mining, advanced/statistical analysis, and data manipulation. - Familiarity with healthcare reimbursement methodologies and calculations such as DRGs, Revenue Codes, CPT Codes, RVUs, bundled payments, etc. - Master’s Degree, especially with a quantitative focus (e.g. data science, machine learning, statistics, mathematics, computer science, or engineering) - Preferred. - Working knowledge of healthcare claims; specifically, differences between institutional vs professional billing and various sites of care/service - Preferred. - Familiarity with value-based care and utilization management - Preferred. - Understanding data systems and critical thinking skills to solve new problems and adapt to changes in data architecture - Preferred. Requirements - High speed internet over 10 Mbps. - Ability to plug in directly to the home internet router for all call center employees. Benefits - Comprehensive benefits including health insurance benefits to qualifying employees.

• Lead Analytics Strategy & Impact Define and execute the analytics strategy for Evolent, aligned to organizational goals and the MCAP Gain Share agreement. • Monitor performance indicators, identify emerging trends, and surface opportunities for operational, clinical, and financial improvement. • Advance value‑add analytics offerings using enterprise capabilities such as clinical data marts and risk‑score assets. • Deliver Actionable Insights Serve as a trusted advisor to internal and external partners, translating complex data into clear insights and practical recommendations. • Present findings through polished, executive‑ready narratives that inform strategy and drive decision‑making. • Lead delivery of both standard reporting and high‑impact ad‑hoc analyses across medical economics, membership, and specialty analytics. • Build and Mentor a High‑Performing Team Manage and develop a geographically distributed team of analysts, promoting collaboration, innovation, and continuous improvement. • Drive clarity, structure, and prioritization across workstreams, ensuring high‑quality output and effective capacity management. • Foster a culture of technical excellence, curiosity, and professional growth. • Scale Analytics Capabilities Lead development of automated solutions, scalable data products, and reusable analytical frameworks. • Oversee quality assurance and ensure accuracy, consistency, and reliability of all analytics deliverables. • Improve team processes and leverage Agile or similar project delivery methodologies to drive execution efficiency.

Role Description Associate Director, Technical Operations (Arlington, VA) – Telecommuting Permissible. (multiple positions). - Manage proprietary application workflow, daily product/data operation and support key systems, functionalities including web-based applications. - Lead operations for software services and support key clients in operational efforts, including defect management for business operations. - Own the Incident Management 2.0 process and implement process for the organization. - Manage Tier 2 support team, lead daily standup, and oversee day-to-day operations. - Collaborate with internal stakeholders, including team members from Production Operations, Engineering, and other business stakeholders where necessary for resolution of issues. - Define central testing strategy and validate test plans across workstreams. - Build new ticket platforms using Jira and Salesforce and end-to-end validation for functionality. - Perform SQL queries on relational database for data validation, identify relationships, facts, and dimensions. - Perform system, unit, performance, load, regression, stress, and data interface testing. - Determine common source of errors and iterate the build to production environment. - Participate in Release and Bug-Review meetings with QA and product managers. - Supervise a team of seven junior software developers. - Mentor, develop and coach team junior members to increase their effectiveness and engagement. - Partner with the Site Reliability Engineering team and bridge the gap between IT operations while focusing on automating infrastructure & monitoring domains/systems. Qualifications - Master’s degree or foreign equivalent in Information Systems, Information Technology, Computer Science, or related field. - Two (2) years of experience in the job offered or in a position responsible for the entire Software Development Life Cycle of a product using Agile methodologies. - Two (2) years of experience within the healthcare industry in each of the following: - Performing log analysis using Kibana and defect analysis using SQL, Kusto Query Language (KQL), Azure App Insights, and Open telemetry via Datadog. - Providing guidance to create indexing solutions and query optimization based on the entity relationship with MS SQL Server database design engine. - Operationally supporting and leading value-based care and client initiatives to improve population health using Microsoft Dynamics 365 CRM software. - Developing SSIS packages for Extract, Transform, and Load solutions. - Creating automation solutions in RPA by preparing PDDs (Process Design Documents) and maintaining several BOTs as batch processes via Automation Anywhere tool. Requirements - High-speed internet over 10 Mbps. - Ability to plug in directly to the home internet router for all call center employees. Benefits - Comprehensive benefits including health insurance benefits. Company Description Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. 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.

Role Description Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Our Actuarial Team offers candidates the opportunity to support our partners to accelerate and enable their value-based care strategies. We are advocates for creating patient value and demonstrate this by ensuring that our financial arrangements are actuarially sound and sustainable. Collaboration Opportunities: - The Analyst, Actuarial Services utilizes and develops analytical tools to solve complex business challenges. - This role supports both medical cost management activities and business development efforts. What You Will Be Doing: - Analyze claims and authorization data to identify trends, calculate cost of healthcare, and identify medical cost savings opportunities for customers. - Perform rigorous actuarial modeling and forecasting to support gainshare and ROI arrangements. - Streamline documentation and processes to improve efficiency of key deliverables. - Support ad hoc analyses to provide data-driven insights for specific business questions from company leadership and partners. - Ability to work independently with cross-functional teams. - Consistently deliver high-quality, error-free deliverables. - Communicate actuarial concepts and concerns within the actuarial department. - Interact with teams of actuaries and non-actuaries, including support for team engagement and strategy. Qualifications - Bachelor’s degree, preferably with a quantitative major (e.g. actuarial science, statistics, mathematics, economics, data science) – Required. - 1+ actuarial exams passed - Required. - Strong proficiency with Microsoft Excel – Required. - Strong communication skills – Required. - Experience in a health actuarial setting - Preferred. - Experience in claims-based healthcare analytics to drive decision making - Preferred. - Familiarity with PowerQuery/BI/VBA – Preferred. - Ability to read and write SQL code – Preferred. Requirements - To ensure a secure hiring process, we have implemented several identity verification steps, including submission of a government issued photo ID. - We conduct identity verification during interviews, and final interviews may require onsite attendance. - All candidates must complete 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 prohibited and monitored. - Misrepresentation will result in immediate disqualification from consideration. Technical Requirements - We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps. - Specifically for all call center employees, the ability to plug in directly to the home internet router. Benefits - The expected base salary/wage range for this position is $72,000. - 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.

• Analyze claims and authorization data to identify trends, calculate cost of healthcare, and identify medical cost savings opportunities for customers • Perform rigorous actuarial modeling and forecasting to support gainshare and ROI arrangements • Incorporate business expectations for the financial impacts of clinical integration, population management processes, provider contracts, and benefit structures into rates and financial projections • Manage organizational risk through forecasting of financial/statistical data in a manner which is actuarially sound • Ability to lead and work independently with cross-functional teams • Consistently deliver high-quality, error-free deliverables • Manage several projects at varying phases, and ensure projects meet strategic objectives and are managed to timelines • Interact with and coach teams of actuaries and non-actuaries, including support for team engagement and strategy • Present reports and analyses to clients and internal executives • Manage a junior actuarial team member

Role Description The Coordinator, UM Intake at Evolent provides support to the Utilization Management Team. The coordinator will support administrative operations by ensuring the efficient intake, review and processing of documents. The general administrative support given will contribute to the overall effectiveness of the department. Collaboration Opportunities: The Coordinator, UM Intake reports directly to the Manager, UM Intake. In support of our daily operations this individual also works with our prior authorization and clinical review teams. Opportunities to work collaboratively with other UM staff including our leadership team both clinical and non-clinical may also be available. What You Will Be Doing: - Prepare inbound faxes for coordinator processing which includes reviewing content and label editing to ensure accurate document classification. - Review Service Level Agreement Grids to determine appropriate turnaround timeframes (TAT) based on health plan, product type, line of business, code and priority. Accurately calculate and document the TAT. - Monitor the failed fax dashboard to identify unsuccessful transmissions and coordinate the re-sending of correspondence via appropriate channels. - Oversee and respond to requests in a shared email inbox by reviewing clinician inquiries, retrieving requested clinical documents and attaching them for timely case review. - Assist with additional administrative tasks as assigned, demonstrating flexibility, strong attention to detail, and the ability to adapt to evolving department needs. - Meet established UM Intake Objective and Key Results. Qualifications - A high school diploma or GED. (Required) - 1 – 3 years of experience in a population management or managed care/insurance or hospital medical management department setting. (Required) - Basic knowledge of medical records with the ability to locate and verify member details. (Required) - Familiarity with health insurance lines of business (Commercial, Medicare, Medicaid) to correctly identify and classify incoming documents based on plan type. (Required) - Working knowledge of medical coding system including CPT/HCPCS codes to differentiate between medical and pharmacy prior authorization requests. (Required) - Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors. (Required) - Proficient using computer and Windows PC applications (Outlook, Word, Excel and OneNote), which includes strong keyboard and navigation skills. (Required) - Team oriented, demonstrates a strong work ethic and committed to productivity. (Required) - Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment. (Preferred) Requirements - To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. - We conduct identity verification during interviews, and final interviews may require onsite attendance. - All candidates must complete 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 prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements - We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps. - Specifically for all call center employees, the ability to plug in directly to the home internet router. Benefits - The expected base salary/wage range for this position is $. - 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. Company Description 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.

• Organize and synthesize clinical value data, metrics, and narratives for presentations, reports, and other communications aimed at both clinical and non-clinical audiences • Act as a bridge between the Clinical Services - Medical team and internal stakeholders (e.g., operations, Performance, Product, finance, and business development) to ensure consistent and effective translation of clinical programs' value propositions • Lead and coordinate specific projects within the different specialty utilization management, including timelines, milestones, and deliverables across different value pools and clinical initiatives • Maintain visibility into the performance and productivity across the utilization management staff, helping to collate success metrics and identify areas for improvement • Prepare materials for internal strategy sessions, external client meetings, and organizational leadership briefings on clinical program performance and value creation • Identify opportunities to streamline project management workflows, improve communication between clinical and non-clinical teams, and enhance reporting practices