Medical Policy Manager jobs in Maryland

Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Policy Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

U
Policy Manager
  • University of Maryland Medical System
  • Towson, MD FULL_TIME
  • Job Description

    The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
    1. Maintain current knowledge of national clinical practice standards and standards of practice from all regulatory agencies including the Magnet Recognition Program®, Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), etc. Collaborate regularly with Quality and Safety Department to ensure that policies and guidelines address TJC standards.
    2. Work collaboratively with clinical and non-clinical support departments and hospital leadership to close identified gaps, create standard work, and improve systems and processes related to policy documents.
    3. Facilitate and coordinate Policy Oversight Committee.
    4. Engage with MEC and system-level leadership to identify appropriate representation of UM SJMC at system-level committees
    5. Lead all work surrounding policy management, development, approval, and UMMS Tier 1 and Tier 2 policy changes that directly impact UM SJMC.
    6. Performs other duties as assigned

    Company Description

    When you come to the University of Maryland St. Joseph Medical Center, you’re coming to more than simply a beautiful 37-acre, 218-bed suburban Baltimore, Maryland campus. You’re embarking on a professional journey that encourages opportunities, values a team atmosphere, and makes convenience and flexibility a priority. Joining our team of healthcare professionals means you’ll be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog Group as a grade ‘A’ hospital and by U.S. News & World Report as #3 in both the state and Baltimore Metro area, making UM St. Joseph the highest-ranking community hospital in Maryland. In addition, we’ve been consistently recognized as a top employer by Baltimore magazine. 

    Qualifications

    Education and Experience
    1. Five years of experience in nursing required.
    2. Bachelor of Science in Nursing required.
    3. Licensure as a Registered Nurse in the State of Maryland, or eligible to practice due to Compact State agreements outlined through the Maryland Board of Nursing, is required.
    4. Minimum of three (3) years of experience in a leadership role (Senior Clinical Nurse and/or Management)
    III. Knowledge, Skills and Abilities
    1. Clinical and professional knowledge regarding current issues affecting healthcare delivery, quality management and professional practice is required. Knowledge regarding group dynamics, organizational change and methodologies for affecting change through leadership are required.
    PAGE 2
    2. Ability to independently develop and manage organizational level projects. Ability to plan, organize and follow through on projects.
    3. Demonstrated success in a leadership role exhibiting teaching, coaching and development skills.
    4. Demonstrated effectiveness in a consultative role at the organizational level.
    5. Knowledge of database management and data analysis is required. Experience with Smartsheet strongly preferred.
    6. Demonstrated use of a statistical software package is preferred
    IV. Patient Safety
    Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
    1. Takes action to correct observed risks to patient safety.
    2. Reports adverse events and near misses to appropriate management authority.
    3. Implements policies, procedure, and standards consistently in the performance of assigned duties.
    4. Develops effective working relationships and maintains good communication with other team members.
    5. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

    Additional Information

    Physical Requirements and Physical Demands
    *Adequate hearing to perform job duties in person and over the telephone. Hears alarms/telephone/tape
    recorder/normal speaking voice.
    *Must be able to accurately document pertinent information either by writing or typing.
    *Must be able to communicate clearly in person and over the telephone.
    Balancing: Occasionally within shift (1-33%)
    Bending: Occasionally within shift (1-33%)
    Climbing: Occasionally within shift (1-33%)
    Crawling: Occasionally within shift (1-33%)
    Crouching: Occasionally within shift (1-33%)
    Kneeling: Occasionally within shift (1-33%)
    Lift above shoulders/head: Occasionally within shift (1-33%)

    Lift from floor level up: Occasionally within shift (1-33%)
    Lift from waist level up: Occasionally within shift (1-33%)
    Lifting 10 lbs. maximum and occasionally lifting and/or carrying articles: Occasionally within shift (1-33%)
    Lifting 20 lbs. maximum and frequent lifting and/or carrying of objects weighing up to 10 lbs: Occasionally
    within shift (1-33%)
    Pulling with force: Occasionally within shift (1-33%)
    Reaching above head: Occasionally within shift (1-33%)
    Reaching above shoulder: Occasionally within shift (1-33%)
    Sitting: Frequently within shift (34-66%)
    Squatting: Occasionally within shift (1-33%)
    Standing: Occasionally within shift (1-33%)
    Walking: Frequently within shift (34-66%)
    Working Environment
    May be exposed to dust/particulate matter.

  • 16 Days Ago

U
Nurse Manager, Nursing & Patient Care Services Policy Oversight & Integration
  • University of Maryland Medical System
  • Baltimore, MD FULL_TIME
  • Job DescriptionGeneral Summary Works independently under limited supervision of the Director. Provides leadership in the development, implementation and evaluation of programs with focus on clinical p...
  • 13 Days Ago

U
Nurse Manager (RN), Nursing & Patient Care Services Policy Oversight & Integration
  • University of Maryland Medical System
  • Baltimore, MD FULL_TIME
  • Job DescriptionGeneral Summary Works independently under limited supervision of the Director. Provides leadership in the development, implementation and evaluation of programs with focus on clinical p...
  • 1 Month Ago

C
Medical Policy Analyst (Remote)
  • CareFirst BlueCross BlueShield
  • Baltimore, MD FULL_TIME
  • 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 ...
  • 3 Days Ago

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Policy and Disputes Analyst (Medical Claims)
  • Tanaq Management Services LLC
  • Rockville, MD FULL_TIME
  • DescriptionOverviewTanaq Management Services (TMS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in the health, agriculture, t...
  • 23 Days Ago

C
Senior Medical Policy Analyst (Remote)
  • CareFirst
  • Baltimore, MD FULL_TIME
  • Resp & Qualifications PURPOSE: We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFi...
  • 12 Days Ago

M
Head of Medical Writing
  • Morgan Prestwich - Life Science & Healthcare Executive Search
  • Company Overview Morgan Prestwich is thrilled to be representing our client on an exclusive basis. Our client is a clini...
  • 3/29/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Orem, UT
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Folsom, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Medical Lead - Oncology, Medical Affairs
  • SEC Life Sciences
  • One of the world's leading pharmaceutical companies is seeking four passionate, forward-thinking individuals for key rol...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Menifee, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/27/2024 12:00:00 AM

F
Medication Management Associate
  • Fresenius Medical Care
  • Bluffton, IN
  • PURPOSE AND SCOPE: Promotes quality patient care, ongoing customer support and case management for Fresenius Medical Car...
  • 3/27/2024 12:00:00 AM

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Executive Director, Head of Medical Affairs, Immunology
  • RBW Consulting
  • Philadelphia, PA
  • A major international pharma business is looking to expands its immunology pipeline and requires a dynamic and forward t...
  • 3/25/2024 12:00:00 AM

Maryland (US: /ˈmɛrələnd/ (listen) MERR-əl-ənd) is a state in the Mid-Atlantic region of the United States, bordering Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware to its east. The state's largest city is Baltimore, and its capital is Annapolis. Among its occasional nicknames are Old Line State, the Free State, and the Chesapeake Bay State. It is named after the English queen Henrietta Maria, known in England as Queen Mary. Sixteen of Maryland's twenty-three counties border the tidal waters of the Chesapeake Bay estuary and...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Manager jobs
$134,620 to $164,348

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