Senior Medical Policy Research Consultant

Blue Cross Blue Shield of Minnesota•Eagan, MN

8d•Hybrid

About The Position

About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have As a member of the Medical Policy Team, the Senior Medical Policy Research Consultant is responsible for participating in development of medical policy strategy and development. This position is responsible for researching and analyzing the medical literature, clinical practice guidelines, and federal and state coverage decisions with the intent of developing medical policies for BCBSM and our national business, and researching new technologies and reviewing existing technologies for presentation to internal technology assessment groups, BCBSM committees and external stakeholders when applicable.

Requirements

5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Knowledge of medical literature and technology assessment evaluation methods.
Demonstrated ability to analyze findings from the current medical literature and develop written conclusions regarding medical technology assessment in the areas of: clinical effectiveness, measurable health outcomes, and safety and appropriateness.
Knowledge of local and national health care environment and trends.
Ability to work independently, and deliver a product that is defensible before internal and external stakeholders.
Ability to effectively communicate the results of research to multiple audiences in both verbal and written forms.
Excellent interpersonal skills.
Must possess the ability to build and maintain relationships with internal stakeholders, clinicians, regulatory agencies and others.
Project Management experience.
High school diploma (or equivalency) and legal authorization to work in the U.S.

Nice To Haves

Bachelor's or Masters degree in a health related field with 5 years experience working in a health care environment (e.g. health care policy or clinical guidelines development).
Knowledge of CPT and ICD-9 coding helpful.

Responsibilities

Develops medical policies for BCBSMN, and assure that changes in medical policies and supporting rationale are communicated to all lines of business, including Medicare, internal stakeholders and others as needed.
Presents medical policy recommendations and supporting rationale to BCBSMNs Medical and Behavioral Health Policy Committee, Coverage Committee (executive-level committee), and other key groups.
Participates as a team member in internal BCBSMN technology assessment committees.
Serve as internal consultant to Medical Directors and staff on emerging medical technology issues.
Serves as external consultant to providers, vendors, manufacturers, government agencies and other organizations on the technology evaluation and medical policy processes.
Participates in BCBSMN efforts to respond to regulatory and accreditation requirements (e.g., NCQA accreditation).
As part of the Medical Policy Team, researches and analyzes scientific literature and medical policies around a clinical field to develop an organized, strategic approach taking into account the business integration into the policy development process.
Manage medical policy-related projects.