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Job Description
- Req#: 79844
Employer Industry: Healthcare System
Why consider this job opportunity:
- Opportunity for career advancement and growth within a nationally recognized healthcare organization
- Collaborative work environment that values compassion, innovation, and integrity
- Engage in meaningful work that enhances health and well-being for over 200,000 members
- Supportive governance committees for policy review and approval
- Involvement in research and policy development impacting healthcare compliance and standards
What to Expect (Job Responsibilities):
- Research and draft medical, administrative, and reimbursement policies based on clinical evidence and regulatory requirements
- 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
- Maintain accurate documentation and version control of all policies
What is Required (Qualifications):
- Bachelor's degree in a related field or equivalency
- Three years of experience in health plans, policy development & maintenance, healthcare, and/or compliance
- Demonstrated intermediate skills in internet database searches
- Strong analytical and technical writing skills
- Knowledge of healthcare economics, reimbursement practices, and regulatory compliance
How to Stand Out (Preferred Qualifications):
- Bachelor's degree in a clinical science (e.g., nursing, medical technology) or health-related field
- Certified professional coder
#Healthcare #PolicyDevelopment #CareerGrowth #HealthcareCompliance #Research
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