Behavioral Health Medical Policy Analyst

This is a fully remote position, open to applicants in Florida.

📋 Description

• Support the Chief Medical Director, Medical Management, and Utilization Management Operations by providing technical writing and research related to clinical practices, policies, guidelines, and technology evaluations.

• Perform research utilizing evidence-based criteria and authorization protocols to aid in clinical decision-making.

• Assist in the technical evaluation of new medical technologies and procedures.

• Facilitate full transparency of medical policies to members and providers via web portals and provider manuals.

• Conduct research for the Special Investigations Unit to detect instances of fraud, waste, and abuse.

• Provide research and criteria to support legal actions concerning clinical policies.

• Collaborate with claims, configuration, and claims dispute teams to ensure accurate implementation of medical policies within the claims system.

• Monitor timelines and revise clinical policies to comply with state, federal, and accreditation standards.

• Assist in the annual and on-demand updates of Clinical Coverage Guidelines, Claims Edit Guidelines, and Clinical Practice Guidelines.

• Maintain and track matters related to the development and maintenance of medical, pharmacy, and behavioral health policies.

• Support governing committees, including the Medical Policy Committee and Claims Payment Policy Committee.

• Engage in cross-functional teams that address significant clinical policy matters.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• A Bachelor's Degree in Medical Technology, Life Sciences, or a related field, or equivalent experience.

• A minimum of 3 years of experience in healthcare, analysis, technical writing, or health administration.

• Proven experience in drafting technical publications within the healthcare sector.

• Registered Nurse (RN) designation preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.