Medical Policy Implementation Analyst Sr

Medical Policy Implementation Analyst SrRemote in ID, OR, WA, UTPrimary Job PurposeThe Medical Policy Implementation Analyst Sr identifies, recommends, and publishes clinical policy criteria for all lines of business.

Organizes and maintains policies so they are accessible to internal and external customers. Consults with Medical Directors and other internal staff on policy development and implementation as well as system application.

General Functions and Outcomes* Effectively drafts, interprets, and applies medical policies and assists in the workload distribution of the medical policy team.

Present policy criteria recommendations to Medical Directors and other internal staff for approval.* Appropriately applies procedural and diagnostic coding (CPT, HCPCS, and ICD) to policy criteria with an understanding of the impact on policy implementation.

• Implements, maintains, and publishes on the web a library of clinical criteria that is accessible to internal and external customers.
• Works with system users and databases to ensure consistent application and implementation of policies.* Develops and maintains related department procedures.
• Ability to manage project tasks, set objectives, goals, and develop schedules while meeting deadlines and documentation requirements for accreditation standards with minimal supervision.
• Interprets the policy criteria for entry into CWQI Guideline Modification Module for clinical review.* Advise and communicate with internal and external stakeholders regarding policy questions, decisions, outcomes.

Minimum Requirements* In-depth knowledge of anatomy and physiology, disease processes, medical and CMS policies, MCG criteria, clinical utilization management, case management or behavioral health management.

• Competency interpreting and applying CPT, ICD, and HCPCS coding for medical technologies, procedures, and services.* Familiarity with utilization review and clinical claim review process.
• Demonstrated analytical ability to identify problems, develop solutions, and implement a chosen course of action with internal and external medical professionals and other experts.
• Strong organization skills, independent worker, and proficiency in Microsoft Office and various Web-based internet applications.
• Ability to communicate effectively, verbally and in writing.* Ability to appraise, summarize, and present research and clinical practice guideline recommendations to inform policy criteria.
• Demonstrated success with project management and ability to serve as key member of project team.Normally to be proficient in the competencies listed aboveMedical Policy Implementation Analyst Sr would have a Bachelor's degree in health science or related field (e.

g., nursing, public health) and 5 years of experience in working with medical policies and 3 years of direct clinical experience or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.* Certified Professional Coder (CPC) preferred. If no CPC currently, employee must attain CPC within 6 months of hire.

Register Nurse (RN) license (must have a current unrestricted RN license)#LI-RemoteThe expected hiring range for a Medical Policy Implementation Analyst Sr is $82,500 - $111,600 depending on skills, experience, education, and training;

relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10% .

The current full salary range for this role is $77,000 - $127,000.Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits.

In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current.

Some highlights : * medical, dental, and vision coverage for employees and their eligible family members* annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)* paid time off varying by role and tenure in addition to 10 company holidays* up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)* up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)* one-time furniture and equipment allowance for employees working from home* up to $225 in Amazon gift cards for participating in various well-being activities.

for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law.

A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.

com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.