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Empower the improvement of healthcare by connecting patients, providers, and payers with intelligent, evidence-based solutions to enable better outcomes. Our purpose is our promise.
eviCore has brought together thousands of experts with diverse backgrounds and skillsets to create a talented team of individuals who connect the dots between the patient, provider, and plan. eviCore is guided by a leadership team that operates under a shared vision of success: to transform our industry through healthcare innovation and by extending our portfolio of integrated medical benefits management solutions, services, and products.
Learn more about our Executive Team here.
Locations & Corporate Headquarters
400 Buckwalter Place Blvd.
BLUFFTON, SC 29910
COLORADO SPRINGS, CO
ST. LOUIS, MO
WEST SENECA, NY
Learn More About Life at eviCore
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eviCore healthcare by Evernorth is now part of The Cigna Group. Together, we want to change healthcare to make it more affordable, more personalized, and more focused on helping the whole person to achieve better health outcomes.
It takes a lot of moving parts to move the needle on the healthcare system. Here are some of the groups working to improve the quality of life. See which one is the right fit for you.
Associate Medical Directors
Our Associate Medical Directors are empowered to make a difference in people’s lives by improving the quality of care for patients, providers, and payers. This team reviews clinical requests. Physicians review cases on the eviCore portal or on peer-to-peer calls to determine the appropriate evidence-based clinical decision. This model allows Associate Medical Directors to make a difference by supporting over 100M patients annually.
Clinical Reviewers (RN & LPN)
Nurse Clinical Reviewers are responsible for all clinical certification activities, which include assessing requests for authorization of clinical services from various healthcare professionals, comparing requests against established clinical protocols, and authorizing services or referring requests for expert clinical review as appropriate. Decisions and determinations are consistent with eviCore’s policies and URAC and NCQA principles. If criteria are not met, the Clinical Reviewer will refer to physician review.
Our Genetic Counselors are responsible for laboratory molecular and genetic testing clinical case review activities, which include evaluating requests for authorization of coverage of molecular and genetic laboratory requests, comparing requests against established clinical protocols, and authorizing coverage of services or referring requests for expert clinical review as appropriate. Our Genetic Counselors serve physicians and labs as expert advisors on the appropriate use of genetic testing, including new and cutting-edge tests entering the market.
Post-Acute Care (PAC)
Post-Acute Care manages patients for up to 90 days following discharge from the acute setting.
PAC provides dedicated nurse case managers and nursing support, personalized plans of care, and re-admission prevention. Areas of expertise include:
- Medicare/Medicaid Dual Eligibility and Commercial Memberships
- Managed Care
- Home Health
- Long Term Care
- Transition of Care
- Durable Medical Equipment (DME)
- Skilled Nursing.
Clinical reviewers are responsible for performing prospective and retrospective reviews given clinical information to determine the medical necessity of skilled care for physical, occupational, and speech therapy services. Determinations are consistent with eviCore’s clinical review protocols and guidelines and follow URAC standards. Responsibilities also include completing peer-to-peer consultations with providers.
The improvement of healthcare starts with eviCore’s Non-Clinical Contact Center (NCCC), the first point of contact for offices and providers. Our Non-Clinical Intake Representatives manage the general patient experience through the life of a prior authorization, primarily through patient and provider phone interactions. The representative’s experience through the NCCC process revolves around creation of prior authorization cases, validating the status of cases, interfacing with clinical teams when clinical intervention is required, and providing case determination by way of specialized notifications.
Our Consumer Engagement Department helps ensure that patients receive the right care, at the right time, through patient education and empowerment. The Educator apprises plan members about their available options when choosing a facility for high-tech radiology scans ordered by their physicians. The Educator connects members with vital information they need to make an informed decision on how to best use their healthcare dollars.
The Claims Department handles all incoming healthcare claims, including reviewing, researching, and processing the medical claims. The department ensures that all member, provider, fee schedules, and contract information is loaded correctly to enable the highest level of customer service and productivity and the accurate processing of claims the first time. The department is also responsible for all claim appeals, provider credentialing and accreditation, network imaging, consultative quality programs, and internal department quality programs. This is complex and detailed work, performed in a fast-paced and challenging environment. The job calls on you to be thoughtful, resourceful, team-driven, and customer-focused.
The Client Experience Team is responsible for ensuring that eviCore’s programs meet all client expectations, including the efficient handling of service issues reported by the client or provider, managing of program changes, and communication of program performance and value.
Provider Engagement optimizes the provider’s experience with eviCore by establishing and implementing a comprehensive strategy for the programs and procedures that strengthen and expedite the utilization management process.
Contact Center Management
Our Contact Center Management Team is responsible for the daily supervision, coaching, and development of team members in our Non-Clinical Contact Center. They monitor workflow and efficiency to guarantee that productivity standards and quality metrics are achieved. Their managing of Contact Center employees includes conducting timely performance reviews and evaluating opportunities for promotion and mobility.
The Program Operations Department synchronizes business requirements, decisions, solutions, and actions amongst all key stakeholders—internal and external to the organization. The department is also responsible for overall ownership of new and existing business integration, program monitoring and performance, and efficiency and efficacy of program initiatives—to impact profit and loss while maintaining regulatory compliance and satisfaction amongst all stakeholders.
Workforce Management (WFM) ensures staffing effectiveness in order to achieve client performance guarantees. WFM teams forecast call volumes, create respective staffing plans, and manage intraday schedule adherence of clinical and non-clinical phone-facing resources.
Network Operations is responsible for the development, management, and administration of high-performing specialty provider networks. These networks provide our health plan partners’ members with access to high-quality/cost competitive medical services.
The Accounting Team comprises the Client Accounting team, which handles all financial and accounting matters related to revenue and medical cost calculations for eviCore’s customers, and the Corporate Accounting team, which covers all other aspects of accounting such as payroll, fixed assets, expense coding and payments, and leases.
The Compliance Department ensures that eviCore fully meets its ongoing obligations to its clients, providers, and patients, in alignment with the vast array of legal and regulatory requirements to which we must adhere, and—most important— is conducted according to the highest ethical standards. Compliance professionals partner with leaders of all of the various operational and administrative groups of the company to design programs, provide research and guidance, and solve and innovate compliance solutions.
Facilities and Administration
Our Facilities and Administration Team maintains the core infrastructure of our organization. Our Administration staff ensures the efficient and smooth day-to-day operation of our corporate engine by providing support to our managers and employees, assisting in daily office needs, and managing our company’s general administrative activities. Our Facilities employees are responsible for servicing our eviCore locations and ensuring the maintenance, security, and safety of our offices.
Finance & Strategy
The Finance & Strategy Department is responsible for accounting and financial reporting, financial planning and analysis, customer pricing and underwriting, and strategic evaluation of M&A acquisition opportunities. The department tracks, reports, and forecasts the Company’s financial performance while making determinations on how to grow the business—organically through innovative pricing of client programs and inorganically via acquisitions of other businesses.
The Legal Department handles matters such as corporate governance, contract drafting and negotiation, litigation, and regulatory affairs. The Legal Department also provides advice to management on risk and compliance with government rules, and coordinates the Company’s government-affairs activity.
People and Talent
Creating a vibrant and dynamic culture with highly engaged employees is a top priority at eviCore. Our People and Talent Department is made up of the HR Compliance, Payroll & HRIS, People Relations, Talent Management, and Total Rewards Teams. Together, they consult, design, and guide the people strategy to fulfill eviCore’s mission and vision.
The Data Science branch of the organization is focused on providing actionable insights into our business practices as well as solutions to enhance their potential. We utilize techniques from statistics, machine learning, deep learning, and artificial intelligence and collaborate with our business, operations, and clinical counterparts to implement real, visible change.
Information Technology (IT)
IT provides the technology to support our customer needs, from applications, to data management, to facilitating our predictive intelligence and advanced analytics. IT also supports our organizational infrastructure—from the system on your desk, to the advanced call center and telecom systems that enable the multiplicity of our corporate operations.
Located in the heart of Boston, the inQbator is eviCore’s innovation hub. This elite team of data scientists and engineers work on the cutting edge of artificial intelligence, natural language processing, and machine learning to solve the most vexing problems in the delivery of healthcare. eviCore's inQbator model empowers this team to research, prototype, and deploy new solutions that ensure patient safety, remove the drudgery from clinical and administrative workflows, improve outcomes, and increase value for our clients and the healthcare system as a whole.
IT Project Management Operations
The IT Project Management Operations team partners with the Executive and IT teams of the business to determine which technology investments should be undertaken by the company. Additionally, this department is responsible for all stages of carrying out the technology investment, from planning the structure to creation, communication, and tracking the results. They ensure the right IT initiatives are being deployed and also delivered on time, at budget, and within the agreed scope and resources.
The Software Engineering team is responsible for designing, developing, testing and implementing software applications and tools that are scalable, flexible, reliable, secure and maintainable in order to meet the needs of our clients, both internal and external. These applications and tools enable growth of our business while building a platform for our systems to integrate and expand seamlessly, supporting the strategy to create differentiating value propositions and competitive advantages for eviCore.
Analytics prove the value of eviCore’s programs to our clients, and support our clinical leads to improve and expand our programs. We are expert data scientists, analysts, and methodologists focused on providing insight to our clients, our programs, and our industry.
eviCore’s Marketing team is responsible for maximizing the client experience and awareness of eviCore’s solutions, capabilities, and products. We employ concerted campaigns that use traditional, digital, or social marketing methodologies to promote a partnership with our clients and prospects. Marketing is also responsible for all corporate collateral, brand management, lead generation, event/sponsorship coordination, CRM management, proposal development, content administration, Web and intranet development and management, video creation, marketing research, industry and competitive intel, and internal and external communications. Marketing enforces brand usage and promotes consistency across all client/prospect-facing materials.
Sales & Growth
Our Sales & Growth Team is regarded as a trusted advisor to our clients and prospects, creatively working with them to develop innovative solutions to their needs. Drawing upon the myriad talents of trained professionals who ensure eviCore can understand and articulate client needs, the Sales organization consistently works with our external partners to ensure a complementary and successful relationship.
What does a typical day look like at eviCore? The answer is that it looks a little different for everyone. Learn more about the people who work every day towards the improvement of healthcare.
Here at eviCore, our number one priority is to build a dynamic company culture with highly engaged and empowered employees. Our team guides the way we do business, as individuals and as a team. See who we are and how we work.
EMPOWER We encourage the freedom to discover, explore, take chances, stretch ourselves, and grow.
COMMIT We fully own the work and the outcome, deliver on what we promise, and expect the same from others.
CONNECT We share our knowledge, vision, and enthusiasm for learning, and highly value eviCore’s diversity.
SUPPORT We hear and respect team members, embrace feedback to grow, and reward strong performance.
Empowerment is a practice of sharing information, rewards, and power with employees so you can take initiative to make decisions and solve problems. eviCore employees have the skills, resources, authority, opportunity, and motivation to make a difference in people’s lives by innovating and improving the quality of care for patients, providers, and payers.
eviCore Customer Service Week
This year eviCore celebrated Customer Service with the theme of empowerment. To rejoice our strides in improving care, we went back in time to the 1940s, a decade when our nation was united in a common cause as we are within the company today. Citizens were empowered to make a difference by relying on and trusting each other. Every day, we are empowered to improve care for patients. Customer Service Week was a blast to the past, filled with fun events from the 1940s including vintage snacks, classic movies, nostalgic games like jacks and hopscotch, and iconic posters.
Nurses’ week is a week of company events, fun and recognition to honor the eviCore nursing staff, and this year we had the pleasure of celebrating over 800 nurses. At eviCore, our nurses inspire us to do what is right to promote safe and proven healthcare, they innovate by optimizing care and improving safety, and they influence all of us by reminding us that at the end of the day we are all here to serve the patient. They are truly superheroes. The notable work they do continues as they seek to provide comfort and reassurance to not only their patients, but also to their clinical and non-clinical “partners” in the physician’s office.
Bluffton evi Day
Our annual Bluffton, SC office eviDay is a family-friendly event that allows eviCore employees to enjoy a day of face painting, trivia, pizza, snow cones, bowling, and arcade games. Attendees can tour Bluffton fire trucks courtesy of the Bluffton Fire Department. This year, thanks to the generosity of our employees, we collected 270 back-to-school items for some appreciative eviCore families suffering temporary hardship.
United Way Campaign 2018
Our annual United Way Campaign helped us wrap up 2018 and bring in the new year with great success. The 2018 United Way Campaign was an exciting community outreach endeavor inclusive to our entire staff through onsite and online activities, including three "pie in the face" competitions, pancake breakfasts, multiple bake sales, holiday dress-up days, PTO raffles, and so much more. Together, the eviCore team raised over $60,000. These generous dollars provide important local support around our major locations, and will help the United Way build stronger communities through improvements in education, financial stability, and health.
Diversity & Inclusion
We rely on thousands of teammates with diverse backgrounds and skillsets to empower the improvement of healthcare for all. To continue fostering growth and success for eviCore, it’s important that our workforce reflects the 1 in 3 people that we touch so that we can best meet and anticipate their needs. Not only do we want to attract and create a workforce that reflects that, we want eviCore to be a place where people can bring their true selves to work and grow their careers here. Whether it's through our inclusive culture, development opportunities, Employee Resource Groups, or having courageous conversations, we're building and sustaining a diverse and inclusive workplace and workforce.
eviCore is a nationwide military partner committed to employing military spouses and veterans. We actively recruit these individuals through career fairs and partnerships with local military affiliations. Accordingly, we encourage former-military members to explore our openings and see how they might serve to help build a better health system for America. Veterans play a key role in our success and we have many in various roles throughout the organization.
“I’m so impressed with eviCore’s culture and the way that colleagues and management care about our employees. When my husband came back from a 10-month deployment, there was so much excitement and support from my HR team I couldn’t believe it. eviCore and the leadership will do everything possible to grow and support your career!”
– Erica Gough, Military Spouse & Lead Talent Acquisition Specialist
Network for the Empowerment of Women
eviCore has recently launched the employee network group Network for the Empowerment of Women (N.E.W.), which seeks to make a difference for women in the workplace by raising visibility, providing opportunities to develop leadership skills and broaden network, and researching and recommending solutions to issues affecting women. This network is still evolving and growing with intention to spread across offices and to our remote workforce. We are excited to launch more employee network groups in more locations in the near future.
Purpose-driven, dedicated to enabling better outcomes
eviCore healthcare is a purpose-driven and giving organization, dedicated to enabling better outcomes. We actively support our employees volunteering for organizations and events that need our assistance. It is our goal to empower the improvement of healthcare—and our communities.
Volunteer Community Service Program
At eviCore we believe in getting involved in the communities where we work and live. Developing a sense of giving back is fundamental and part of our culture. We offer Volunteer Community Service Days for our employees, so they can take company-supported time out of their workweek to help causes in the community that mean the most to them.
United Way Event - Owl's Hill Nature Sanctuary
Several eviCore employees volunteered at a United Way event that took place at the Owl’s Hill Nature Sanctuary. The sanctuary, a non-profit organization located in northern Williamson County, Tennessee, is dedicated to a mission of environmental education, restoration, and preservation. eviCore volunteers enthusiastically assisted in gardening and cleaning of the facilities.
Our Bluffton, SC office partners with the Palmetto Animal League to sponsor a “Pause-4-Paws” event that allows employees to take a break from the workplace and spend time with adoptable animals. This event leads to adoptions, and employees donate pet food, laundry detergent, money, tons of toys, and countless cuddles to support the local non-kill shelter.
Nashville Rescue Mission
eviCore’s Post-Acute Care QA team recently volunteered at the Nashville Rescue Mission, helping serve lunch and donating clothes, coats, and shoes to support the Mission’s annual coat drive. The team was able to meet people from all backgrounds, participate in acts of kindness and compassion, and hear stories of overcoming hardships. According to one volunteer, “The more we learned about the Mission and what they do to help homeless women and children, the more we wanted to get involved.
eviCore healthcare gives generously to local charitable and community-improvement causes, both through its employees and as an organization. For example, within the last year, we supported a Hurricane Relief Fund for our own employees affected by Matthew, Harvey and Irma. We also supported the American Heart Association as well as numerous local organizations/schools in our communities.