Clinical Policy Manager Jobs

Preparing presentations and policy papers to other policy professionals, lawyers, lawmakers, and government officials;

Supporting the development and maintenance of policymaker coalitions;

preparing presentations and policy papers to other policy professionals, lawyers, lawmakers, and government officials;

supporting the development and maintenance of policymaker coalitions;

in qualitative and/or quantitative policy analysis

Experience/knowledge of claims processing with a working knowledge of different claim types is desired.

Bachelor's degree or four (4) years’ relevant work experience. (Required)

Current certification as a professional coder (RHIA, RHIT or CPC). (Required)

Claims processing systems and product configuration experience including familiarity with supplemental tables and product configuration.

This is a Work from Home Opportunity!!

Identify potential patterns and/or trends to confirm alignment of code payments, changes and denials, and medical policy changes.

Former project management or equivalent experience

Lead ongoing communication and change management efforts as a result of new or revised policies

High level Roles and Responsibilities include:Assist Global HR Policy Lead with all aspects of HR Policy Governance oversight

Shepherd document owners through the HR Policy Governance process; including Council and Client Policy Committee requirements

Oversees HR Policy’s inventory and ongoing maintenance requirements including the recording and tracking of dispensations, waivers, breaches, tracks document pipeline

Manages Global HR Policy Governance inquiries, mailbox

High organizational and time-management skills; ability to work independently.

Working knowledge of clinical policies.

Understanding of the managed care industry and market conditions.

Excellent and clear written and verbal communication skills.

Strong analytical and problem-solving skills.

Clinical experience, nursing, therapy, social work background

Minimum of 5 years' experience in healthcare industry with in-depth knowledge of managed care, post-acute care, DME and/or home health marketplace.

Experience or advanced knowledge of evidence based clinical research is required.

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.

Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.

Advancement Opportunities, professional skills training, and tuition /exam reimbursement.