Molina Healthcare

Analyst, Clinical Policy

Molina Healthcare$70K — $95K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 4+ years of clinical or literature research analysis experience in healthcare or equivalent education.
  • Familiarity with clinical policies and guidelines.
  • Understanding of the managed care industry and current market conditions.
  • Strong organizational and time-management skills for independent work.
  • Analytical skills to solve complex problems in healthcare.
  • Excellent written and verbal communication abilities.
  • Proficiency with Microsoft Office and Adobe Acrobat, along with online collaboration tools.

Responsibilities

  • Review and evaluate existing clinical policies on an annual basis.
  • Identify new evidence impacting current policies, including technologies and pharmaceuticals.
  • Recommend improvements to enhance current clinical policies.
  • Draft and amend policies, ensuring quality checks for approval readiness.
  • Facilitate communication with stakeholders about clinical policy needs.
  • Gather data to create reports regarding clinical policy effectiveness.
  • Collaborate with certified coders for accurate policy coding.

Benefits

  • Comprehensive health benefits package.
  • Support for professional development and growth.
  • Opportunities for collaboration across teams and functions.
Full Job Description
JOB DESCRIPTION Job SummaryProvides analyst support for clinical policy review activities. Supports review and evaluation processes of existing clinical policies, proposes suggested improvements to existing policies, and facilitates research for new policy creation in alignment with market trends, changes and practices across the industry. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Reviews and evaluates existing clinical policies due for annual review. • Determines any new evidence in areas related to existing policies including new technologies and pharmaceutical drugs. • Proposes suggestions to improve existing clinical policies. • Edits and amends existing policies, and write new policy drafts, including assistance with final quality checks to ready for approval. • Assists with final quality checks on presentations, reports, or procedural document management. • Liaises with internal and external stakeholders to determine needs and goals of clinical policies. • Gathers data and produces reports related to clinical policy. • Collaborates with certified coders to ensure proper coding of policies. • Analyzes market trends and conditions for upcoming clinical policy needs. • Participates in group projects related to clinical and payment policies including efforts to improve department processes. Required Qualifications • At least 4 years of related experience, including clinical and/or literature research analysis experience in the health care industry, or equivalent combination of relevant education and experience. • Working knowledge of clinical policies. • Understanding of the managed care industry and market conditions. • Strong organizational and time-management skills; ability to work independently. • Strong analytical and problem-solving skills. • Ability to work in a cross-functional, professional environment. • Exceptional team player with a strong ability to contribute positively to a team environment with a desire to learn, grow, and empower. • Ability to perform independent research on complex medical topics. • Excellent and clear written and verbal communication skills. • Knowledge and ability to operate online platforms such as Microsoft Teams, etc. • Microsoft Office suite and Adobe Acrobat proficiency. Preferred Qualifications • Clinical experience (i.e. nursing, therapy, and/or social work background). • Experience writing clinical policy. • Knowledge of National Committee for Quality Assurance (NCQA) regulations. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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