Clinical Planning and Policy Analyst

Alliance Health•Durham, NC

1d•Remote

About The Position

The Clinical Planning and Policy Analyst is responsible for supporting the policy analysis, writing and research activities by identifying, obtaining, organizing and analyzing quantitative and qualitative data, reviewing academic and professional literature and gathering information from multiple sources on cost, utilization, quality and access to health care services. This role is pivotal in shaping healthcare policies that address critical challenges and promote equitable and efficient healthcare delivery. The position requires strong analytical, communication and management skills. Additionally this position supports documents management activities within the Clinical Planning and Policy team. This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.

Requirements

Bachelor’s degree in health policy, health services research, social science or a related field and three (3) years of experience evaluating, analyzing, researching, and developing health care services, policies, and programs.
Extensive experience evaluating, analyzing, researching, and developing health care services, policies, and programs
Experience in working in health policy topics, Medicaid, Medicare, and commercial insurance medical necessity guidelines, and working knowledge of integrated health care systems
Demonstrated analytical skills, natural problem solver
Ability to highlight key insights within a complex set of data, synthesize large amounts of information, and then clearly explain these insights to various stakeholders
Comfortable working under pressure and tight deadlines in a fast-paced environment
Excellent interpersonal skills, especially ability to interface effectively with stakeholders of varying disciplines, background, and expertise
Selected candidate must reside in North Carolina

Nice To Haves

Master’s degree in health policy, health services research, social science or a related field and five (5) years of experience evaluating, analyzing, researching, and developing health care services, policies, and programs.
Lean Six Sigma certification preferred

Responsibilities

Conducts qualitative research informed by NC expansion to Medicaid and designs medical necessity criteria to ensure medically appropriate services as outlined by the member’s benefit package
Regularly consumes industry and policy specific news to incorporate current trends into research and analysis and communicates relevant changes to Alliance’s internal and external stakeholders
Assists in reviewing state developed clinical coverage policies, facilitates internal discussion and feedback during public comments periods, and collaborates closely with the Waiver Manager in submitting the feedback to the regulators
Facilitates activities related to the Medical Policy Committee meetings including meeting materials development, action items monitoring and dissemination of adopted Clinical Coverage Policies through the established channels
Under the guidance of the Program Manager and other clinical leadership, assists the department with research and all other related tasks for clinical practice guidelines aligned with industry standards
Serves as a resource for medical policy- related questions and issues and provides technical advice and assistance to staff regarding new medical policies and clinical coverage guidelines
Develops and implements workforce supports and trainings related to medical policies and related topics
Acts as the department liaison with the internal Communication team and other stakeholders as appropriately to assure proper internal and external communication for medical policies and related documentation
Serves as the the project manager for the overall activities related to medical policies, Medical Policy Committee and other committees as assigned
Develops and implements adequate work plans for project improvement activities related to medical policies and clinical practice guidelines
Support the overall activities related to standardized documents management within the Clinical Planning and Policy portfolio (policies, procedures and other standardized documents)
Assists with the development, upload, upkeep and organization of diverse content sources within the Clinical Operations knowledge repository
Develops, implements and follows strategies that drive content accuracy and quality, ensuring that sources are up-to-date and trustworthy
Other duties as assigned