Medical/Clinical Policy Writer (Work From Home)

Job Summary:

Medical/Clinical Policy Writer research and develop moderate to complex Medical/Clinical, BH, and Reimbursement policies; ensure adherence to company, state, and federal guidelines.
Essential Functions:

- 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 the development and implementation of policies and procedures

- Ensure all medical policies are compliant 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 policies policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products and other markets as business needs change

- Coordinate with subject matter experts to develop policy on issues that impact CareSource from medical/clinical, BH, and reimbursement policies 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

- Knowledge of NCQA policy timely requirements

- Perform any other job duties as requested

Education and Experience:

- Bachelor’s degree or equivalent years of relevant work experience is required

- Advanced degree or equivalent education/degree in life sciences/healthcare is preferred

- Minimum of two (2) years of healthcare-related writing experience preferred; clinical and managed care backgrounds preferred

- Minimum of two (2) years of experience in medical policy development and/or implementation preferred

- Strong presentation skills

Competencies, Knowledge and Skills:

- Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software

- Knowledge of medical terminology and claims payment policies

- Strong clinical expertise and healthcare administration understanding

- Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature

- Ability to interpret complex clinical information and apply to policy development

- Excellent verbal and written communications 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/projects simultaneously

Licensure and Certification:
- RN or equivalent clinical licensure preferred, or in lieu of licensure: 2 years Clinical /Medical policy writing experience or equivalent Policy/Healthcare experience

Working Conditions:
- Virtual office opportunity (WFH), occasional travel to main office; may require sitting/standing for long periods of time

Compensation Range:
$72,200.00 - $115,500.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary Organization Level Competencies

-
Fostering a Collaborative Workplace Culture

- Cultivate Partnerships

- Develop Self and Other