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
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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