Medical Policy Analyst Sr. (JR130671)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.
Familiarity with medical coding desired.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.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.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Full-time