Teams at Evry Health

Conducts prior authorization, concurrent, and retrospective utilization reviews using MCG guidelines, medical policies, and benefit structures. Coordinates care and discharge planning, evaluates medical necessity, monitors quality concerns, escalates complex cases, and collaborates with providers, facilities, and physician reviewers. Supports coding, documentation, appeals, denials, and reimbursement issues while educating members telephonically. This is a remote role requiring rotating weekend utilization review coverage and strong clinical documentation and communication skills.

Lead design and implement scalable backend systems using Node.js, build RESTful APIs, design SQL schemas, optimize performance, mentor engineers, deploy on Azure, and maintain CI/CD, security, and observability.