Medical/Clinical Policy Writer (Work From Home)

CareSource•Virginia, MN

7d•$72,200 - $115,500•Remote

About The Position

The Medical/Clinical Policy Writer researches and develops moderate to complex medical/clinical, behavioral health (BH), and reimbursement policies while ensuring adherence to company, state, and federal guidelines. The role supports the operational processes of the Policy Governance Committee and monitors status reports to help ensure effective workflow and timely policy development. It supports internal departments in policy and procedure development and implementation, and ensures medical policies comply with relevant regulations and remain consistent across lines of business. The position researches clinical and scientific literature and consensus guidelines, creates and updates policy bibliographies, and prepares work products for team input and to inform CPC. It collaborates with health plan business product leaders, specialty companies, corporate leaders, subject matter experts, business product owners, government relations, compliance leads, and interdisciplinary team members. Policy deliverables may support Medicare, Medicaid, MyCare, D-SNP, Marketplace products, and other markets as business needs change. The role monitors legislative and regulatory activity for potential effects on existing or proposed policies, participates in department initiatives and projects, and performs other duties as requested. This is a virtual work-from-home opportunity with occasional travel to the main office. The role may require sitting or standing for long periods. The listed compensation range is $72,200 to $115,500, with possible eligibility for a bonus tied to company and individual performance. CareSource also describes a substantial and comprehensive total rewards package.

Requirements

Bachelor’s degree or equivalent years of relevant work experience.
Strong presentation skills.
Proficiency with Microsoft Word, Excel, search engines, and bibliographic software.
Knowledge of medical terminology and claims payment policies.
Strong clinical expertise and understanding of healthcare administration.
Advanced analytical skills, including the ability to interpret and synthesize complex healthcare literature.
Ability to interpret complex clinical information and apply it to policy development.
Excellent verbal and written communication 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 and projects simultaneously.
Knowledge of NCQA policy timeliness requirements.

Nice To Haves

Advanced degree or equivalent education/degree in life sciences or healthcare.
At least two years of healthcare-related writing experience; clinical and managed care backgrounds are preferred.
At least two years of experience in medical policy development and/or implementation.
RN or equivalent clinical licensure; alternatively, two years of clinical/medical policy writing experience or equivalent policy/healthcare experience.

Responsibilities

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 developing and implementing policies and procedures.
Ensure medical policies comply 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 policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products, and other markets as business needs change.
Coordinate with subject matter experts to develop policies on issues affecting CareSource from medical/clinical, BH, and reimbursement 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.
Perform other job duties as requested.