Medical Policy Analyst Rn

All about us

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

Work environment

This opportunity is eligible for a remote, hybrid, or in-office work arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

This position is eligible for internal Blue Cross Blue Shield employees and external applications.

Pay information

Pay Level: 023

FLSA Category: Exempt-Salaried

A day in the life

The Medical Policy Analyst is responsible for research, analysis, evaluation, and the development of medical policies. This role drives decision making regarding medical policy development, ensures policies are implemented and integrated with all systems, and organizes communication of changes to internal partners and external stakeholders.

Your responsibilities will include

• Collaborates with key internal stakeholders to develop recommendations for benefit plan design changes and implement new code updates.
• Develops, maintains, and implements medical policies and guidelines to meet regulatory requirements for preventative benefits.
• Supports and serves as a liaison to other departments for medical policy issues, questions, and implementation of policies.
• Facilitates and participates in cross-functional workgroups to prioritize and submit project requests to appropriate vendor(s).
• Provides support and back-up to the team such as assisting with appeals activities, analyzing data, maintaining processes and procedures, and preparing information for ad-hoc requests and projects.
• Prepares communications and reports for internal and external audiences regarding medical policy, coding, and benefit implementations.
• Prioritizes work and determines which medical policies are required for next review in order to meet regulatory requirements and contract standards.
• Utilizes expertise to identify operational improvements with new analysis/reporting capabilities, project management techniques and/or engagement approaches.
• Represents the division at company operational meetings and on assigned corporate projects.
• Identifies, analyzes, and monitors industry, regulatory, technology and market-based trends that affect medical policy, health care quality, utilization studies, pre and post services, appeals and other related initiatives.

What you need to succeed

• 3 years of acute medical or clinical experience in healthcare, utilization review, medical policy review, quality management, or related experience.
• North Dakota (ND) Registered Nurse (RN) License or RN License valid for work in ND
• An Associate's degree in Nursing, but a Bachelor's degree is highly preferred.
• Have an analytical mindset when problem solving.
• Be able to collaborate and communicate well with others on the team.
• Skilled in research and analysis using clinical expertise.
• Experience working in a managed care/health plan organization and coding background is preferred.

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Benefits and perks

• Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
• Employee recognition, community initiative events and yearly company outings.
• Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.

Job posting policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email [email protected].

This job posting will be closed 4/17/2023 at 8:00 a.m. (CT). No further applications will be considered.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)