Georgia Licensed Clinical Policy Manager

A company is looking for a Manager, Vendor Clinical Policy to join their Clinical Policy team.

Key Responsibilities

Clinically evaluate vendor policy sets for compliance with medical standards and organizational goals

Vet vendor policy sets for affordability opportunities and ensure adherence to departmental strategy

Track deliverables and prepare materials for executive review, ensuring compliance with regulatory requirements

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

4+ years of experience in utilization management and / or clinical operations

Working knowledge of medical coding (CPT, ICD-10, HCPCS) and claims