Medical Policy Analyst Sr (United States)

Anthem, Inc. New Haven , CT 06501

Posted 4 weeks ago

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 benefits companies and a Fortune Top 50 Company.

Location: United States and must live within one (1) hour of an Anthem office.

The Medical Policy Analyst, Sr. is responsible for researching, drafting, and maintaining Corporate medical polices and clinical UM guidelines ensuring the use of valid and consistent research methodologies and the creation of documents aligning with the most rigorous scientific evidence.

Primary duties may include, but are not limited to:

  • Conducting structured research of the peer-reviewed literature and other resources within defined methodologies using consistent templates, tools, and criteria to support:

  • Evaluation and assessment of potential new topics for development into Anthem's medical policy and clinical UM guidelines

  • Maintenance of existing medical policies clinical UM guidelines

  • Reviewing new and updated codes for appropriate application within the policy and guideline framework

  • Working with key stakeholder to assess Enterprise need for new and revised medical policies and clinical UM guidelines on new and evolving topics

  • Collaborating across Enterprise-wide workgroups and business units to facilitate proper implementation of medical policies and clinical UM guidelines

  • Responding to internal and external inquiries that warrant written clarification of a general or specific questions regarding medical policy and clinical UM guideline issues

  • Coordination and collaboration with Anthem subsidiaries on issues of mutual interest related to medical policy and clinical UM guideline topics

Qualifications

Qualifications:

  • Requires a BA/BS in a related field (Biology, Chemistry, Nursing, etc.) or a RN (having an Associate's Degree or higher)

  • 5 years of related experience in Research in a science related field.; or any combination of education and experience, which would provide an equivalent background (i.e. Clinical Research, Medical Policy Research, basic science research, Public Health)

  • Clinical or medical policy research experience is required

  • Working knowledge of medical coding required

  • Nursing degree, MPH, or equivalent preferred

  • Experience and familiarity with genetics and genetic testing desired

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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Medical Policy Analyst Sr (United States)

Anthem, Inc.