SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
Location: Remote Based
The Medical Policy Analyst, Sr is primarily responsible for developing new and maintaining existing corporate medical policies and clinical utilization management (UM) guidelines.
Primary duties may include, but are not limited to:
Conduction of literature searches and evaluation of scientific articles using epidemiological methods to assess quality and utility of new and existing technologies, treatments, and, procedures
Writing new or revising medical policies and clinical UM guidelines using standard templates, tools, and criteria
Review of new and updated codes for applicability to new and existing policy or guideline documents.
Survey of competitor and other payor positions
Identification and evaluation of relevant authoritative organizations' recommendations for inclusion in development process.
Responding to internal and external inquiries related to medical policy issues.
Reviewing and customization of MCG guidelines.
Requires at least a BA/BS degree in a scientific or clinical field and a minimum of 5 years related experience; or any combination of education and experience which would provide an equivalent background
Working knowledge of coding
Experience with policy, clinical, or basic science research experience.
Limited travel may be required
Nursing degree or MPH preferred
Active state RN license preferred
Familiarity with epidemiological principles and applications preferred
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.