• Create and maintain client profiles by accurately inputting information into the client's system • Work closely with clinical staff to retrieve necessary information required for processing patient claims • Verify the completeness and accuracy of client information, make necessary updates, and review and analyze claim documentation for compliance with established guidelines and requirements • Maintain confidentiality and handle sensitive information by established protocols • Assist in the development and implementation of process improvements to enhance efficiency and quality • Maintain effective working relationships with colleagues using appropriate interpersonal and communication skills

• Reviews Provider request for relevant and complete supporting documentation and requests for missing or additional documentation from providers per guidelines. • Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN has the authority to authorize services or procedures. • If a request does not meet established clinical guidelines for appropriateness and medical necessity, the request is sent to a physician reviewer. • Verifies accuracy of codes and services and applies them accurately with appropriate documentation. • Ensures regulatory guidelines are met for timeliness and use of medical review criteria. • Acts with honor and integrity, serving as a role model for the company while establishing and maintaining professional relationships with Providers and office staff. • Complies with HIPAA requirements and all Evolent policies and procedures. • Performs other duties as assigned including and not limited to develop report data elements.

• Medical Records Review & Quality Assurance • Perform final quality reviews of completed medical record requests before delivery to clients. • Verify the accuracy, completeness, organization, and consistency of medical records. • Identify missing documents, inconsistencies, clinical errors, and documentation gaps. • Ensure all deliverables meet company quality standards. • AI-Assisted Medical Review • Review and validate AI-generated medical summaries, chronologies, and case insights. • Apply clinical knowledge to refine, correct, and enhance AI-generated outputs. • Ensure summaries accurately reflect the underlying medical documentation. • Issue Identification & Escalation • Detect deficiencies, missing information, or quality concerns within completed requests. • Escalate issues to the appropriate internal teams for timely resolution. • Communicate findings clearly and professionally. • Process Improvement • Provide feedback on AI performance, document processing workflows, and internal review tools. • Collaborate with engineering and product teams to improve AI models and operational processes. • Share observations that help enhance review accuracy and efficiency.

Title: Physician Kelsey Seybold Allergy at Springwoods Village Location: Spring United States Job Description: Requisition number: 2343572 Job category: Healthcare Delivery Overtime status: Exempt Travel: No Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. Position Highlights: The Department of Allergy and Immunology for Adults provides consultative services for the diagnosis, evaluation and management of diseases of the respiratory tract, immune system and allergies. The Allergy/Immunology department provides consultation in the diagnosis and management of allergies and immune-deficiency diseases. A multidisciplinary team of physicians and nurses offers patient management, patient/family education and support services. Some of the chronic ailments and illnesses treated are: asthma, food or drug allergies, and insect hypersensitivity. Essential Duties And Responsibilities include the following. Other assignments, projects and duties may be required: - Interviewing patients and families - Performing complete physical examination - Ordering appropriate diagnostic studies, diets, and nursing monitoring and intervention - Recognition of clinical problems and formulation of a logical diagnosis - Evaluation and management of adult/pediatric allergy and immunological conditions which may or may not pose the threat of death, organ or system failure, irreversible organ or system failure, irreversible damage or loss of permanent impairment of a body function - Evaluation and management of allergy and immunological diseases - Interpretation of diagnostic laboratory studies - Allergy testing: percutaneous, antibiotics, biologicals, stinging insects' antigens, intradermals - Immunizations - Ingestion challenge testing - Inhalation therapy - Application of local and topical anesthesia What makes an Optum Career different? - Be part of a best-in-class employee experience that enables you to practice at the top of your license - We believe that better care for clinicians equates to better care for patients - We are influencing change collectively on a national scale while still maintaining the culture and community of our local care organizations - Practice medicine autonomously, with the support, not restrictions, of a sustainable and thriving national health care organization You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - Graduate of an approved training program in the United States - Board Certified and/or Board Eligible - Licensed in the state of Texas Compensation for this specialty generally ranges from $254,000 - $485,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.