Medical / Clinical Policy Writer

Job Summary :

Medical / Clinical Policy Writer research and develop moderate to complex Medical / Clinical, BH, and Reimbursement policies; ensure adherence to company, state, and federal guidelines.

Essential Functions :

• Support the operational processes of the Policy Governance Committee
• Monitor status reports to ensure effective workflow and timely development of medical and pharmacy policies
• Support internal departments and processes in the development and implementation of policies and procedures
• Ensure all medical policies are compliant with relevant regulations and are consistent across all lines of business
• Participate in department initiatives and projects
• Research clinical and scientific literature and consensus guidelines to create work products for team input and to inform CPC
• Create and update policy bibliographies
• Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities
• Provide medical / clinical, BH, and reimbursement policies policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products and other markets as business needs change
• Coordinate with subject matter experts to develop policy on issues that impact CareSource from medical / clinical, BH, and reimbursement policies policy perspectives
• Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
• Collaborate with interdisciplinary team members to achieve team goals
• Knowledge of NCQA policy timely requirements
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Salary

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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