Texas Licensed Clinical Policy Manager
VirtualVocationsMission Viejo, California, United Statesjob_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_description
A company is looking for a Manager, Vendor Clinical Policy to join their Clinical Policy team.
Key Responsibilities
Evaluate vendor policy sets to ensure compliance with internal and external medical standards
Identify affordability opportunities within vendor policy sets and align them with departmental and organizational goals
Streamline vendor policies and processes to adhere to departmental strategies and track deliverables to meet SLAs and TAT
Required Qualifications
Bachelor's degree in a relevant field (PA, NP, APRN, BSN, or RN)
Active, unrestricted clinical license
4+ years of experience in clinical policy development or evaluation, specifically in health insurance
4+ years of experience in utilization management and / or clinical operations
Working knowledge of medical coding (CPT, ICD-10, HCPCS) and claims
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Policy Manager • Mission Viejo, California, United States
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