Clinical Policy Manager Jobs

In this role, you will support CareCentrix clinical coverage guidelines alignment and product enhancements for market growth. The position will support the development and maintenance of a repository for clinical coverage guidelines and criteria for approval. You will also work closely with the Product team in utilization management goals and objectives, and with operations and Business Technology resources to implement recommendations.

In this role, you will:

• Provide analysis of our partner's clinical guidelines and ensure they align with policies.
• Participate and support the development of best practices for utilization and authorization management of clinical programs by reviewing clinical coverage guidelines and offering best practice recommendation to improve clinical outcomes.
• Support clinical program tools and content to support product portfolio.
• Participate and support the evaluation and review of clinical coverage guidelines in support of our clients as CareCentrix develops and enhances its product portfolio.
• Support and maintain clinical coverage guideline tools to create and log roadmap for review and updates.
• Assess innovation opportunities against clinical coverage guidelines and identify barriers to bringing innovation to market.

Qualifications:

• Minimum of 5 years' experience in healthcare industry with in-depth knowledge of managed care, post-acute care, DME and/or home health marketplace.
• Advanced proficiency in Microsoft Word, Excel, and PowerPoint. Candidate has the ability to navigate the internet for evidence based clinical research, citing references related to advanced clinical literature, scholar articles, and clinical trials.
• Capable of managing multiple tasks and ability to interact and communicate effectively with clients and all levels of management.
• Bachelor's Degree in a transferrable discipline or equivalent experience preferred.
• Experience or advanced knowledge of evidence based clinical research is required.

What we offer:

• Bonus Incentives, Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement.
• Compensation Range: $80000 - 100000K / year plus bonus incentive. The actual salary/rate within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors.
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Walgreens Discount - receive up to 25% off eligible items.
• Great culture with a sense of community.
• PayActiv - access earned income in between pay checks.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.