Evry Health

• Provide accurate and thorough information on commercial health plan benefits, eligibility, and claims. • Handle inbound and outbound calls as well as respond to email inquiries from customers. • Develop processes, call scripts, metrics, and desktop procedures. • Deliver an exceptional customer service experience to Evry members and providers. • Partner with senior leadership daily. • Work effectively in a virtual work environment.

• Provide accurate and thorough information on commercial health plan benefits, eligibility, and claims. • Handle inbound and outbound calls as well as respond to email inquiries from customers. • Develop processes, call scripts, metrics, and desk top procedures. • Deliver exceptional customer service experience to Evry members and providers. • Partner with senior leadership daily.

• System Architecture & Design: Lead the design and implementation of scalable and maintainable systems, ensuring alignment with business requirements and technical standards. • Development & Coding: Write efficient and maintainable code using Node 20 LTS (back-end), Next 15+ (Backend + Front end), React 19+, React Native 0.80+, and Expo SDK 54+ technologies. • Backend & Database Development: Design and optimize SQL database schemas, write complex queries, and implement ORMs. • API Design & Documentation: Create well-documented RESTful APIs ensuring consistency and ease of integration. • Technical Leadership: Provide technical guidance and mentorship to junior engineers. • Performance Optimization: Identify and resolve performance bottlenecks in systems, databases, and APIs. • Collaboration: Work closely with cross-functional teams. • Documentation: Create and maintain technical documentation. • Security & Compliance: Implement and enforce security best practices. • Problem Solving: Troubleshoot and resolve complex technical issues. • Cloud & DevOps: Deploy and manage applications on Azure cloud platform.

• Lead end-to-end technical implementations of our AI tools (both SaaS and on-premise solutions) for enterprise customers • Design and execute custom integrations with customer systems, APIs, databases, and existing workflows • Conduct technical discovery sessions to understand customer infrastructure, requirements, and business objectives • Build proof-of-concepts and pilot programs to demonstrate value and accelerate customer adoption • Troubleshoot complex technical issues and provide rapid solutions to maintain customer satisfaction • Partner with Sales teams to provide technical expertise during the sales cycle, including product demonstrations and solution design • Respond to RFPs, technical due diligence questionnaires, and security/compliance inquiries • Serve as the primary technical point of contact for key enterprise accounts during onboarding • Train customer teams on product capabilities, features, optimal usage patterns, and best practices • Create technical documentation, integration guides, API documentation, and best practice resources • Work with internal departments, vendors, and business partners to coordinate problem-solving effectively • Maintain deep expertise across our full suite of AI tools and stay current with product updates and industry trends • Gather and synthesize customer feedback to inform product development priorities and roadmap • Share customer insights, use cases, and technical learnings with internal Product and Engineering teams • Demonstrate personal responsibility and accountability by meeting project timelines and customer commitments • Effectively excel in a remote work environment through active participation in team meetings, standups, and cross-functional collaboration

• Evaluate and analyze health insurance applications to determine the risk they pose, helping to set premium rates that are both fair and competitive. • Interpret and analyze underlying claims experience to inform underwriting decisions and policy adjustments. • Work closely with sales teams to develop competitive insurance products and strategies, ensuring alignment with company goals and client needs. • Assist in the development of insurance policies or suggest changes to existing policies that balance the needs of market with the risk to the insurance company. • Stay updated with changes in legislation and regulations that may affect the product design and underwriting considerations. • Maintain accurate and detailed records of policies underwritten and decisions made, tracking concessions and experience. • Coordinate with brokers and agents to gather additional information or to explain underwriting decisions.

• Communicate and provide education to members and providers on insurance plan benefits and digital health solutions. • Use negotiation and motivational interviewing techniques to increase engagement. • Pro-active and reactive support for members, including outbound phone/email/text outreach. • Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement. • Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls. • Accurately track and document work on a variety of internal software tools and platforms. • Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers. • Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. • Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals. • Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.

• Lead utilization management strategy, including oversight of medical necessity determinations and review processes • Own medical policy development, incorporating regulatory updates and care guideline changes • Lead and Partner with the Utilization Management Review Committee • Provide medical oversight, expertise, and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members • Promote positive relations with the local medical community, including periodic consultation with providers, facilities, caregivers, etc. • Review case management data to identify trends, gaps in care, and recommend corrective actions • Provide oversight and direction for staff and provider training and education • Integrate clinical quality and best clinical practices into medical management program development • Evaluate the development of new programs and the continuation of existing programs • Investigate future care management and patient engagement technologies and evaluate their impact on providers’ practices, patient safety, and patient experience

• Bring the Evry Health brand to life across every surface our members, brokers, and partners encounter • Serve as the primary creative production resource for all campaigns, communications, and member-facing materials • Support design needs across Sales, Clinical, and Operations • Create visuals that help people quickly scan and understand information • Craft polished sales decks and animate micro-interactions for mobile onboarding flows • Hand off production-ready assets directly to the engineering team

Evry Health is seeking a tech-savvy Nurse to join our team. This is an exciting role allowing the ability to work with members across the continuum with ~75% utilization review and ~25% care coordination. Our teams are 100% virtual. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone. About Evry Health and Globe Life We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company. Roles and Responsibilities - Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions. Presents recommendations based on clinical review, criteria, and organizational policies to physician reviewers for final determination. - Conducts prior authorization, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of care by applying MCG guidelines, medical policy, and benefit structure for defined service requests. - Monitors clinical quality concerns, make referrals appropriately, identify and escalate care quality issues, and quickly identifies outlier cases, long length of stay cases or complicated prior authorization requests. - Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care. - Assists departmental staff with issues related to coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals. - Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement. - Effectively assess and facilitate appropriate utilization of clinical programs and/or discharge planning by thoroughly assessing and screening for proper care coordination following discharge. - Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. - Ability to assist and facilitate working relationship with Medical Director on CM and UM cases. - Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations with positivity, enthusiasm, and helpful personality. - Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls. Experience and Skills Desired - Previous healthcare/managed care appeals experience. - Must have a current, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume. - Diploma from an accredited school/college of nursing required. - You have 1-2 years of experience working at a health plan performing utilization management using standard practice guidelines. - You have working knowledge of medical and insurance industry terminology including basic level CPT/ICD10, authorizations, digital health programs, NCQA/URAC standards. - You have 3-5 years of clinical experience in a hospital or ambulatory setting assisting with direct patient care. - You have a passion for quality, teamwork, problem solving, and critical thinking. - You can work independently and comfortable in a fast-paced, deadline-oriented, tech savy, work environment. - You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology. - You have experience outreaching and educating members telephonically. - You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system. - Bonus: Familiarity with Salesforce/Healthcloud/CareIQ. - Bonus: CCM or ACM certification, MCG certification - Bonus: Appeals experience Telecommuting Requirements - This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. - Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. This position requires work during the stated business hours as well as rotating on-call weekends for utilization review cases. - Required to have a dedicated work area established that is separate from other living areas and provides information privacy. - Ability to keep all company sensitive documents secure. - Must live in a location that receives an existing high-speed internet connection/service. Benefits Package - Competitive salary - Comprehensive health, dental, and vision insurance as well as life and disability - Retirement savings plan with company match - Generous time off/vacation - Professional development opportunities - Flexible and remote work environment Evry Health is an EEO employer - Read More Here

• System Architecture & Design: Lead the design and implementation of scalable and maintainable systems, ensuring alignment with business requirements and technical standards. • Development & Coding: Write efficient and maintainable code using Node 20 LTS (back-end), Next 15+ (Backend + Front end), React 19+, React Native 0.80+, and Expo SDK 54+ technologies, following best practices for software development, including test-driven development and continuous integration. Primary focus will be on backend services, RESTful API development, Next.js API routes, and SQL database design and optimization. • Backend & Database Development: Design and optimize SQL database schemas, write complex queries, and implement ORMs (Prisma, TypeORM, Sequelize, or similar). Build and maintain robust backend services using Express.js, Fastify, or similar Node.js frameworks. • API Design & Documentation: Create well-documented RESTful APIs using OpenAPI/Swagger specifications, ensuring consistency and ease of integration for frontend and mobile applications. • Technical Leadership: Provide technical guidance and mentorship to junior engineers, conducting code reviews, and ensuring adherence to established coding standards and practices. • Performance Optimization: Identify and resolve performance bottlenecks in systems, databases, and APIs, ensuring high availability and reliability of services. • Collaboration: Work closely with cross-functional teams, including .NET core developers and product managers, to deliver software solutions. • Documentation: Create and maintain technical documentation for systems, processes, and codebases to ensure knowledge sharing and continuity. • Security & Compliance: Implement and enforce security best practices, ensuring that backend systems are secure and compliant with relevant regulations and standards. • Problem Solving: Troubleshoot and resolve complex technical issues, providing timely and effective solutions to minimize downtime and ensure smooth operation of systems. • Cloud & DevOps: Deploy and manage applications on Azure cloud platform, implement CI/CD pipelines, and work with containerization technologies (Docker). Familiarity with GitHub actions and workflows.