Medical/Clinical Policy Writer (Work From Home)

CareSource · United States · $72k – $116k · posted today ago

Listing supplied by Himalayas. 101 Careers did not originate this post and applications are handled by the employer.

About this role

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.