Location: Qualified candidates must reside within 50 miles and 1-hour commute each way of one of our open, relevant Elevance Health locations.
Elevance Health supports a hybrid workplace model (virtual and office) with PulsePoint sites used for collaboration, community, and connection, with the minimum in-office commitment for this role being 1 day in an office per week.
The Medical Policy Analyst Sr. is primarily responsible for the development, review, and maintenance of new and existing Elevance Health medical policies and clinical UM guidelines. Primary duties may include, but are not limited to:
Conducts structured research within defined methodologies and analyzes relevant studies and articles to support analysis of potential new medical policies and clinical UM guidelines
Investigates and develops analysis of potential new topics for Elevance Health medical policies and clinical UM guidelines
Drafts new and modifies existing Elevance Health medical policies and clinical UM guidelines using standardized templates, criteria, and processes
Reviews new and updated codes for applicability to existing Elevance Health documents or potential new topics
Assists in drafting written responses to inquiries from internal and external stakeholders regarding medical policies, clinical UM guidelines,
Supports MCG maintenance and customization process
Supports Carelon MBM and Carelon Rx coordination activities
Supports special projects related to internal and external business partner goals
Works closely with operations and other internal teams to support Enterprise-wide needs and goals
Requirements:
BA/BS degree in a related field and a minimum of 5 years related experience; or any combination of education and experience which would provide an equivalent background.
Preferred Qualifications:
RN license preferred.
Clinical research experience desired.
Working knowledge of coding desired.
Nursing degree or MPH preferred.
Extensive experience with scientific and general writing, reading, and critically analyzing scientific literature strongly desired.
Experience and familiarity with MCG guidelines desired.
