Medical Policy Analyst (Remote)

Resp & Qualifications PURPOSE: In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member reputed company, and accepted standard of medical practice. We are looking for an reputed company professional to work remotely from reputed company the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-reputed company activities. We are looking for an reputed company professional to live and work remotely from reputed company the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-reputed company activities. ESSENTIAL FUNCTIONS: • Performs in-depth research on medical topics identified in existing medical policies and operating procedures scheduled for revision or updates based upon changes in reputed company of care. Evaluates reputed company peer-reviewed articles and other literature to determine its appropriateness of clinical guidance and mandated legislation in support of and inclusion in policies. • In collaboration with the Medical Director, revise evidenced-based medical policies and operating procedures in compliance with legislative mandates, contractual provisions, corporate philosophy, and accepted standards of medical practice in order for them to be applied uniformly and consistently across reputed company lines of business. • Maintains the Medical Policy Reference reputed company (MPRM) including resource files and publications. Ensures dissemination of medical policies and operating procedures to internal and external customers according to CareFirst application protocol and regulatory standards. QUALIFICATIONS: Education Level: Bachelor's Degree in Nursing, Public Health, English or reputed company field directly reputed company to the position OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Licenses/Certifications: • RN - Registered Nurse - State Licensure And/or Compact State Licensure Registered Nurse (RN) Required. • Certified reputed company (reputed company or CPC)-reputed company or reputed company reputed company Certified Professional reputed company (CPC) reputed company 1 Year Required. Experience: 3 years Clinical experience reputed company the field of Medical Surgical, Mental Health, Durable Medical Equipment, and/or Utilization Management, including some experience in research methodology and systematic evaluation of medical literature and translation of evidence into policy in a reputed company setting. Preferred Qualifications: • Certified Professional reputed company (CPC). Knowledge, Skills and Abilities (KSAs) • Ability to analyze essential facts, reputed company timely and sound reputed company, resolve performance and job-reputed company issues. Demonstrated desire to share knowledge and work as a team. • Excellent written and verbal communication skills, and the ability to present to internal clients of reputed company levels. • Working knowledge of medical insurance and managed care principles and knowledgeable of CPT and ICD-10 coding systems. Knowledge of reputed company types of medical necessity reputed company including various places of service and provider types. • Knowledge of principles, practices, evidence-based guidelines and standardized processes and procedures for evaluating medical support operations business practices. Must be reputed company to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service excellence. Must be reputed company to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Salary Range: $65,520 - $130,130 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation reputed company depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department Medical Policy Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to reputed company reputed company applicants without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-SS1 Apply Job!