Clinical Policy Writer

Caresource Dayton , OH 45401

Posted 2 weeks ago

Role and Responsibility:

  • Research and develop moderate to complex medical and payment policies; ensure adherence to company, state, and federal guidelines

  • Support the operational processes of the Policy Governance Committee (PGC) as a voting member

  • Monitor status reports to ensure effective work flow and timely development of medical and payment policies

  • Support internal departments and processes in the development and implementation of policies and procedures

  • Ensure all policies are compliant with relevant regulations and are consistent across all lines of business

  • Participate in department initiatives and projects

  • Research clinical and scientific literature and consensus guidelines to create work products for team input and to inform PGC

  • Create and update policy bibliographies

  • Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities

  • Provide policy deliverables for Medicare, Medicaid, MyCare, and Marketplace products

  • Coordinate with subject matter experts to develop policy positions on issues that impact CareSource from medical and payment policy perspectives

  • Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies

  • Collaborate with interdisciplinary team members to achieve team goals

  • Perform any other job related instructions, as requested

Requirements

Education / Experience:

  • Bachelor's degree or equivalent years of relevant work experience is required

  • Advanced degree or equivalent education/degree in life sciences/healthcare is preferred

  • Technical writing experience is required, preferably healthcare policy or related

  • Minimum of two (2) years of experience in policy development and/or implementation preferred

Required Competencies / Knowledge /

Skills:
  • Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software

  • Knowledge of medical terminology and claims payment policies

  • Strong clinical expertise and healthcare administration understanding

  • Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature

  • Ability to interpret complex clinical information and apply to policy development

  • Excellent verbal and written communications skills

  • Presentation and decision-making skills

  • Excellent organization and tracking skills

  • Good problem solving skills

  • Ability to interface with employees at all levels

  • Ability to handle multiple priorities/projects simultaneously

Licensure / Certification:

  • None

Working Conditions:

  • General office environment; may require sitting/standing for long periods of time

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VIEW JOBS 3/8/2019 12:00:00 AM 2019-06-06T00:00 Role and Responsibility: * Research and develop basic medical and payment policies; ensure adherence to company, state, and federal guidelines * Support the operational processes of the Policy Governance Committee (PGC) * Monitor status reports to ensure effective work flow and timely development of medical and payment policies * Support internal departments and processes in the development and implementation of policies and procedures * Ensure all policies are compliant with relevant regulations and are consistent across all lines of business * Participate in department initiatives and projects * Research clinical and scientific literature and consensus guidelines to create work products for team input and to inform PGC * Create and update policy bibliographies * Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities * Provide policy deliverables for Medicare, Medicaid, MyCare, and Marketplace products * Coordinate with subject matter experts to develop policy positions on issues that impact CareSource from medical and payment policy perspectives * Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies * Collaborate with interdisciplinary team members to achieve team goals * Perform any other job related instructions, as requested Requirements Education / Experience: * Associates Degree or equivalent years of relevant work experience is required * Minimum of one (1) year of healthcare-related writing experience preferred; * Minimum of one (1) year of experience in policy development and/or implementation preferred Required Competencies / Knowledge / Skills: * Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software * Basic knowledge of medical terminology and claims payment policies * Strong healthcare services understanding * Analytical skills, with the ability to interpret and synthesize healthcare literature * Ability to interpret clinical information and apply to policy development * Excellent verbal and written communications skills * Presentation and decision-making skills * Excellent organization and tracking skills * Good problem solving skills * Ability to interface with employees at all levels * Ability to handle multiple priorities/projects simultaneously Licensure / Certification: * None Working Conditions: * General office environment; may require sitting/standing for long periods of time Apply On-line Send This Job to a Friend Copyright © Ultimate Software Caresource Dayton OH

Clinical Policy Writer

Caresource