Medical/Clinical Policy Writer (Work From Home)

Job Summary:

Medical/Clinical Policy Writer research and develop moderate to complex Medical/Clinical, BH, and Reimbursement policies; ensure adherence to company, state, and federal guidelines.

Essential Functions:

• Support the operational processes of the Policy Governance Committee
• Monitor status reports to ensure effective workflow and timely development of medical and pharmacy policies
• Support internal departments and processes in the development and implementation of policies and procedures
• Ensure all medical policies are compliant with relevant regulations and are consistent across all lines of business
• Participate in department initiatives and projects
• Research clinical and scientific literature and consensus guidelines to create work products for team input and to inform CPC
• Create and update policy bibliographies
• Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities
• Provide medical/clinical, BH, and reimbursement policies policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products and other markets as business needs change
• Coordinate with subject matter experts to develop policy on issues that impact CareSource from medical/clinical, BH, and reimbursement policies policy perspectives
• Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
• Collaborate with interdisciplinary team members to achieve team goals
• Knowledge of NCQA policy timely requirements
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience is required
• Advanced degree or equivalent education/degree in life sciences/healthcare is preferred
• Minimum of two (2) years of healthcare-related writing experience preferred; clinical and managed care backgrounds preferred
• Minimum of two (2) years of experience in medical policy development and/or implementation preferred
• Strong presentation skills

Competencies, Knowledge and Skills:

• Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software
• Knowledge of medical terminology and claims payment policies
• Strong clinical expertise and healthcare administration understanding
• Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature
• Ability to interpret complex clinical information and apply to policy development
• Excellent verbal and written communications skills
• Presentation and decision-making skills
• Excellent organization and tracking skills
• Good problem-solving skills
• Ability to interface with employees at all levels
• Ability to handle multiple priorities/projects simultaneously

Licensure and Certification:

RN or equivalent clinical licensure preferred, or in lieu of licensure:  2 years Clinical /Medical policy writing experience or equivalent Policy/Healthcare experience

Working Conditions:

Virtual office opportunity (WFH), occasional travel to main office; may require sitting/standing for long periods of time