Average Salary for Jobs with Medical Policy Management Skills

Offers guidance to patients, their families, and professional staff on ethical, legal and policy issues and concerns stemming from clinical interactions between health care professionals and patients. Provides guidance to the institutional ethics committee pertaining to policy formulation and educational and case review activities. Develops institutional policies concerning ethical issues such as ... View job details

Responsible for coordinating with healthcare providers and plan members to maximize member benefits while managing costs. Assesses medical necessity of patient admissions, surgical and diagnostic procedures, and other related services. Conducts pre-certification and/or authorization, and monitors compliance with established medical guidelines and policies. May assist members in appeals for denied ... View job details

Directs and oversees an organization's medical management programs, which may include case management, utilization review, quality management, and/or community health education programs. Collects and analyzes data on utilization, outcomes, costs, and quality to determine trends and identify problem areas. Develops and implements clinical guidelines for care designed to improve outcomes while manag... View job details

Manages an organization's medical management programs, which may include case management, utilization review, quality management, and/or community health education programs. Collects and analyzes data on utilization, outcomes, costs, and quality to determine trends and identify problem areas. Develops and implements clinical guidelines for care designed to improve outcomes while managing costs. Re... View job details

Manages the team responsible for administering the clinical coverage guidelines that determine if medical services, technologies, and/or drugs are covered by an insurance plan. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Confirms the proper codes to use for claims processing. Responds to questions... View job details