TurningPoint is an innovative healthcare services and technology organization that is committed to working with Health Plans and Providers to develop advanced technical and clinical solutions that improve the quality and affordability of surgical care patients receive. We are seeking a highly motivated and results orientated Medical Policy Specialist to join our fast-paced and rapidly growing company.
Position Summary:
The Medical Policy Specialist, as a member of the Utilization Management team, will participate in and may lead clinical programs by assisting with the development and maintenance of evidence-based guidelines and clinical pathways. Acts as a resource for team members and other partners in all processes associated with the implementation of the clinical programs using technology platforms. Will contribute to the growth of various collaborations and clinical initiatives through research, prioritization, quality control, and analyzing stakeholder communications.
Roles and Responsibilities:
- Assists in the training and development of staff
- Establishes and documents clinical policy guidelines that can be utilized by health plans to support quality of care initiatives for their members
- Develops, implements, and monitors a comprehensive project management plan for organizing evidence-based guidelines
- Researches, documents, and creates clinical policies and guidelines for the utilization of EBM
- Maintains clinical policies and guidelines using current evidenced-based guidelines
- Develops comparable effectiveness criteria to assess the performance of implantable devices, providers, and sites of care
- Conducts and documents protocols and best practices to establish medical guidelines that promote utilization of high quality and cost-effective care
- Assists in designing, planning, and implementing clinical projects and new programs/services
- Identifies, evaluates, and gains access to secondary reports: therapeutic journals, guidelines, and regulatory documentation (FDA, ASCO, NCCN, ASTRO, ASH, etc.)
- Develops, implements, and monitors system enhancements related to clinical policies and guidelines
- Works collaboratively with Sr. Management team and Utilization Management/Clinical Services to provide feedback and solutions to client/physician concerns regarding the clinical policies and best practices.
- Serves as a resource to Medical Directors, and other staff members regarding research outcomes and protocols
- Follows company policies and procedures and conducts annual performance reviews in a timely manner
- Respects and maintains HIPAA confidentiality guidelines
- Participates and assists in Utilization Management Committee (UMC) meetings
- Other duties as directed
Education, Experience and Licensure:
- Bachelors or Master’s degree in Nursing or related field
- Two to five years’ experience in the medical industry
- Must possess active license
- Must possess strong organizational skills; commitment to customer service; ability to problem solve
- Requires strong presentation skills to be utilized throughout all levels of the organization
- Must be able to foster a positive and productive work environment with ability to lead, build teams, and motivate staff
Preferred Skills:
- Master’s degree in Nursing
- Experience in Utilization Management /Managed Care environments
- Intermediate proficiency in Microsoft Word, Excel, and Outlook.
TurningPoint offers a number of benefits to full-time employees including, but not limited to: medical, dental, vision, disability, life, PTO. All employees, age 21 and over, are eligible to participate in the 401(k)-retirement savings plan.
Job Type: Full-time