Health Plan Policy Specialist

University of Utah Health • Murray, UT

5d • Remote

About The Position

The Health Plans Policy Specialist is responsible for researching, developing, and maintaining policies to ensure compliance with state and federal regulations, accreditation standards, and organizational objectives. This role conducts evidence-based research, monitors regulatory changes, and collaborates with clinical, legal, and operational stakeholders to ensure policies are accurate, current, and aligned with organizational goals.

Requirements

• Bachelor's degree in a related field or equivalency.
• Three years of health plans, policy development & maintenance, healthcare, and/or compliance.
• Demonstrated intermediate skills in Internet database searches.

Nice To Haves

• Bachelor's degree in a clinical science (e.g. nursing, medical technology), or health related field, or the equivalency.
• Certified professional coder.

Responsibilities

• Research and draft medical, administrative, and reimbursement policies based on clinical evidence, regulatory requirements, and industry standards.
• Ensure policies align with company guidelines, NCQA standards, and applicable laws.
• Collaborate with internal stakeholders to review and approve policies.
• Monitor legislative and regulatory changes impacting health plan policies.
• Support governance committees for policy review and approval.
• Maintain accurate documentation and version control of all policies.
• Provide subject matter expertise for policy interpretation and application.
• Assist in remediation of gaps in existing processes related to policy compliance.
• Respond to inquiries regarding policy requirements.

Benefits

• Save 50% on Tuition (Tuition reduced for eligible employees attending the University of Utah)
• Health Coverage
• Dental Coverage
• Life Insurance
• Retirement
• Paid Time Off
• 11 Paid Holidays per year

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees