Evolent · 2 days ago
Clinical Reviewer, Speech Therapy
United States
Full-time
Remote
Senior Level
5+ years expEvolent is a company that partners with health plans and providers to achieve better outcomes for those with complex health conditions. The Clinical Reviewer for Speech Therapy will evaluate cases in the utilization management team, ensuring quality care standards are met and providing support to medical staff.
Health CareHospitalInformation Technology
Responsibilities
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
Conducts regular audits, as assigned, to ensure guidelines are applied appropriately
In states where required, refers all cases that an approval cannot be rendered to the Physician Clinical Reviewer. In States where allowed, will make denial determinations as a specific case warrants
Converses with medical office staff in order to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale
Provides optimum customer service through professional/accurate communication while 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
Qualification
Required
Current, unrestricted state licensure as a Speech Therapist
A Speech Therapist must hold a state license in Speech Therapy and hold a Speech therapy degree from an accredited education program and pass the national certification examination
Strong interpersonal and communication skills
Strong clinical, communication, and organizational skills
Energetic and curious with a passion for quality and value in health care
Computer Proficiency
Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an 'excluded person' by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare
No history of disciplinary or legal action by a state medical board
High speed internet over 10 Mbps and the ability to plug in directly to the home internet router
Preferred
5+ years clinical experience
Benefits
Comprehensive benefits (including health insurance benefits)
Company
Evolent
Evolent partners with health plans and providers to achieve better outcomes for people with complex health conditions.
1001-5000 employees
H1B Sponsorship
Evolent has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (7)
2024 (16)
2023 (22)
2022 (15)
2021 (17)
2020 (20)
Funding
Current Stage
Public CompanyTotal Funding
$1.17BKey Investors
TPG Growth
2025-08-19Post Ipo Debt· $145M
2023-12-05Post Ipo Debt· $350M
2022-08-11Post Ipo Equity· $125M
Leadership Team
Sarah Alexander
Vice President, Strategic Accounts
Recent News
2026-01-06
2026-01-03
2025-12-22
Company data provided by crunchbase