Texas Licensed Clinical Policy Manager

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