Develops medical policies for ***, and assure that changes in medical policies and supporting rationale are communicated to all lines of business, including Medicare, internal stakeholders and others as needed.
Presents medical policy recommendations and supporting rationale to ***'s Medical and Behavioral Health Policy Committee, Coverage Committee (executive-level committee), and other key groups.
Participates as a team member in internal *** technology assessment committees.
Serve as internal consultant to Medical Directors and staff on emerging medical technology issues.
Serves as external consultant to providers, vendors, manufacturers, government agencies and other organizations on the technology evaluation and medical policy processes.
Participates in *** efforts to respond to regulatory and accreditation requirements (e.g., NCQA accreditation).
As part of the Medical Policy Team, researches and analyzes scientific literature and medical policies around a clinical field to develop an organized, strategic approach taking into account the business integration into the policy development process.
Manage medical policy-related projects, including research and implementation
Required Skills And Experiences
5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Knowledge of medical literature and technology assessment evaluation methods.
Demonstrated ability to analyze findings from the current medical literature and develop written conclusions regarding medical technology assessment in the areas of: clinical effectiveness, measurable health outcomes, and safety and appropriateness.
Knowledge of local and national health care environment and trends.
Ability to work independently, and deliver a product that is defensible before internal and external stakeholders.
Ability to effectively communicate the results of research to multiple audiences in both verbal and written forms.
Excellent interpersonal skills.
Must possess the ability to build and maintain relationships with internal stakeholders, clinicians, regulatory agencies and others.
Project Management experience.
Nice To Have
Bachelor's or Masters degree in a health related field with 5 years experience working in a health care environment (e.g .health care policy or clinical guidelines development).
Knowledge of CPT and ICD-9 coding helpful.
Seniority level
Entry level
Employment type
Full-time
Job function
Research, Analyst, and Information Technology
Industries
IT Services and IT Consulting
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