Research Manager, Medical Technologies
About The Position
The Research Manager, Medical Technologies conducts and leads research related to medical technologies, products, and services to support coverage decisions, utilization management tools—including prior authorization—and medical policy development. The role manages the Medical Technology Assessment Committee and Prior Authorization Committee in collaboration with their chairs, and partners with medical leadership and cross-functional stakeholders to identify policy needs, make strategic coverage and utilization management decisions, support configuration, and align policies with clinical best practices and applicable legal and regulatory requirements. The position prepares committee agendas; researches and summarizes medical literature, benchmarking, coding, regulations, and medical economics; maintains lists of services designated Experimental/Investigational; and makes recommendations on coverage status and utilization management strategies. This is a remote role available from most U.S. states, with Monday-through-Friday Eastern business hours. Remote work requires a stable, secure, quiet, HIPAA-compliant workspace, which will be confirmed via Microsoft Teams video.
Requirements
- At least 3–5 years of research experience related to medical technology and/or healthcare services.
- Strong demonstrated ability to execute work on time, on budget, and on scope.
- Excellent interpersonal skills, including the ability to influence people at all organizational levels.
- Strong research and analytical skills.
- Ability to collaborate with cross-functional teams.
- Working knowledge of medical coding systems, including CPT, HCPCS, and ICD-10, and reimbursement methodologies.
- Familiarity with applicable regulatory and accreditation requirements, such as CMS, state insurance regulations, and NCQA.
- Strong verbal and written communication skills, including preparing clear committee materials and presenting findings to medical leadership.
- Proficiency with Microsoft Office, including Word, Excel, and PowerPoint, and comfort learning claims and coverage policy systems.
- Ability to work Monday through Friday during Eastern business hours.
- Ability to maintain a stable, secure, quiet, HIPAA-compliant remote workspace.
Nice To Haves
- Master's degree preferred; experience may be considered in lieu of a degree.
- At least 2–3 years of health plan, managed care, or health insurance industry experience preferred.
- At least 1–2 years of experience with medical policy development, utilization management, or health technology assessment preferred.
Responsibilities
- Prepare the Medical Technology Assessment Committee agenda in collaboration with Medical Directors and the Manager, Research and Policy Development.
- Research and summarize medical literature, benchmarking, coding, regulations, and medical economics analysis for new medical technologies and products or services designated Experimental/Investigational.
- Update and maintain the list of Experimental/Investigational services for each line of business.
- Recommend coverage status based on synthesized research.
- Prepare the Prior Authorization Committee agenda in collaboration with the chair, co-chair, and analytics team.
- Research relevant coding, benchmarking, and regulations for the Prior Authorization Committee and Medical Policy Committee.
- Recommend utilization management strategies to the Prior Authorization Committee, informed by value factor analysis and other relevant considerations.
- Manage the Medical Technology Assessment Committee and Prior Authorization Committee in collaboration with committee chairs.
- Partner with medical leadership and cross-functional stakeholders to identify policy needs, support strategic policy decisions and configuration, and ensure alignment with clinical best practices and applicable legal and regulatory requirements.
Benefits
- Competitive salaries and a benefits package.
- Flexible work options.
- Career growth and advancement opportunities.
- Comprehensive benefits, differentials, premiums and bonuses as applicable, and recognition programs.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
