Clinical Analyst

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

📋 Description

• Utilize claims analytics to uncover opportunities for the development of coverage criteria and claim edits.

• Assess and critically analyze medical literature as part of developing evidence-based policies.

• Create, review, and maintain coverage criteria based on factors such as age, clinical presentation, risk factors, and other relevant characteristics.

• Deliver written and oral presentations to colleagues and leadership to achieve consensus on proposed criteria.

• Suggest and program rules or logic for denying claims based on established policy criteria.

• Input clinical content into internal tools and databases.

• Collaborate with Customer Operations to provide clinical content support to customers as necessary.

⛳️ Requirements

• Candidates must already possess legal authorization to work in the U.S.

• Visa sponsorship or any immigration support is not available.

• Bachelor's degree in biology, nursing, health sciences, or a related discipline.

• A minimum of 5 years of experience in direct patient care, clinical research, utilization management, payment integrity, revenue cycle management, clinical product development/program management, market access/medical science liaison, or medical writing.

• Proven technological proficiency with software applications such as MS Word, MS Excel, and JIRA or Monday.com or other project management tools.

• Outstanding verbal and written communication abilities.

• Strong analytical capabilities, including the ability to analyze qualitative and quantitative data.

• Familiarity with basic formulas, sorting, filtering, and pivot tables in Excel and similar applications, or a willingness to learn.

🏝️ Benefits

• Equal Opportunity Employer.

• Inclusive work environment.

• Focus on collaborative success.

• Competitive base salary compensation (specific amount not disclosed).