Medical Policy Writer

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

📋 Description

• Conduct research and develop moderate to complex medical/clinical, behavioral health, and reimbursement policies.

• Ensure compliance with company, state, and federal regulations.

• Assist in the operational processes of the Policy Governance Committee.

• Monitor status reports to guarantee effective workflow and timely creation of medical and pharmacy policies.

• Support internal departments and processes in the development and implementation of policies and procedures.

• Ensure that medical policies adhere to relevant regulations and maintain consistency across various lines of business.

• Engage in departmental initiatives and projects.

• Investigate clinical and scientific literature and consensus guidelines to develop work products and inform the CPC.

• Create and maintain policy bibliographies.

• Collaborate with health plan business product leaders, specialty companies, and corporate executives on policy priorities.

• Provide policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products, and other markets as business needs evolve.

• Coordinate with subject matter experts on medical/clinical, behavioral health, and reimbursement policy issues.

• Monitor legislative and regulatory developments alongside business product owners, government relations, and compliance leads.

• Work with interdisciplinary team members to accomplish team objectives.

• Perform additional job duties as assigned.

⛳️ Requirements

• A Bachelor’s degree or equivalent years of relevant work experience is required.

• An advanced degree or equivalent education/degree in life sciences/healthcare is preferred.

• A minimum of two (2) years of healthcare-related writing experience is preferred; backgrounds in clinical and managed care are advantageous.

• At least two (2) years of experience in medical policy development and/or implementation is preferred.

• Strong presentation skills are essential.

• Proficiency in computer skills with Microsoft Word, Excel, search engines, and bibliographic software.

• Familiarity with medical terminology and claims payment policies.

• Strong clinical expertise and a solid understanding of healthcare administration.

• Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature.

• Capability to interpret complex clinical information and apply it to policy development.

• Excellent verbal and written communication abilities.

• Strong presentation and decision-making capabilities.

• Outstanding organization and tracking skills.

• Good problem-solving abilities.

• Ability to interact with employees at all levels.

• Capacity to manage multiple priorities and projects simultaneously.

• RN or equivalent clinical licensure is preferred, or in lieu of licensure: 2 years of Clinical/Medical policy writing experience or equivalent Policy/Healthcare experience.

• Knowledge of NCQA policy timely requirements.

🏝️ Benefits

• Opportunity for a virtual office (work from home).

• Occasional travel to the main office.

• Potential bonus based on company and individual performance.

• Comprehensive and substantial total rewards package.

• Total well-being support offered.