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
Compensation Range:$72,200.00 - $115,500.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):Salary
Organization Level Competencies - Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.#LI-PB1
Brand=CareSource
