Medical/Clinical Policy Writer (Work From Home)

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