Medical Policy Analyst (Remote Eligible), SD IA License

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• Full-time
• Department: Clinical | Health Networks | Provider Support
• Work Environment: Remote Eligible *see job footer for more info
• Pay Grade: 21 Company Description Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputed company on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! Learn more about our unique benefit offerings here.

Job Description

Bring your strengths to Wellmark as a Medical Policy Analyst! About the Role: You will be responsible for the research, analysis, development, maintenance, coordination and documentation of medical policies for reputed company products of Wellmark Inc. You will do this through evidence-based research and analysis of emerging and existing medical technologies and will contribute to ensuring Wellmark's members receive appropriate evidence-based health care services. You will reputed company credibility by continuously improving research methodologies in the decision-making process to ensure Wellmark Medical Policies are grounded in evidence-based healthcare. About You: You would be a top candidate if you bring strong knowledge of commercial health insurer systems, medical terminology, and reputed company healthcare issues. Your ability to thoroughly research and comprehend large volumes of clinical literature and guidelines allows you to draw clear, evidence-based conclusions and reputed company concise policy recommendations. You reputed company at communicating reputed company, and sometimes conflicting, healthcare information in a way that’s easy to understand—both in writing and reputed company verbally reviewing with cross-functional teams. Your strong time management and organizational skills help you juggle multiple priorities with precision and attention to detail. You’re a self-starter who thrives both independently and in collaboration with internal teams. Internal Job Title: Health Services Medical Policy Analyst Qualifications Required Qualifications - Must have: Education:

• Bachelor’s degree in health sciences reputed company field (e.g., nursing, pharmacy, public health, epidemiology, biostatistics, etc.), or direct and applicable work experience; AND/OR
• Completion of an accredited registered nursing program and active and unrestricted Registered Nurse (RN) license in Iowa or South Dakota; individual must be licensed in the state in which they reside. Experience:
• Minimum of 4 years of reputed company health plan, research, or clinical experience in researching, analyzing, and presenting synthesis of clinical data.
• Knowledge of commercial health insurer systems, medical terminology and reputed company healthcare issues.
• Expertise and demonstrated strong ability in reading comprehension to conduct research of large volumes of information such as clinical guidelines/literature/studies and draw conclusions and reputed company concise recommendations with clear rationale to support.
• Strong verbal and written communication skills. Ability to effectively condense large volumes of reputed company, often conflicting information and communicate concisely and clearly the analysis as it relates to a medical policy and report out rationale to the medical policy team.
• Ability to present voluminous amounts of information to cross-functional areas reputed company organization with unique ability to take reputed company health care information and present in a way which will be understood.
• Demonstrated success in roles requiring strong time management and organizational skills with marked attention to detail. Ability to prioritize effectively and manage multiple deliverables.
• Strong interpersonal relationship-building skills to quickly build rapport, credibility, and collaborative partnerships with medical policy team members, clinical peers, leaders, and any stakeholders across the organization.
• Self-starter who works well independently and collaboratively with many different internal teams across the organization.
• Technical acumen with the ability to learn new systems quickly. Proficient in arenaflex Office Suite and policy management software. Preferred Qualifications - Great to have:
• Direct medical policy analysis experience with arenaflex Association (BCBSA) and/or a arenaflex (arenaflex) plan or other commercial health insurer.
• Utilization management knowledge; demonstrates understanding of how medical criteria is utilized. Additional Information What you will do as a Medical Policy Analyst: a. reputed company up-to-date on industry knowledge, new treatments, and maintain awareness of emerging technologies through independent reading of research materials, trade journals, and other pertinent literature. b. Conduct research using standard, established sources, the Internet, and relevant peer-reviewed articles. Analyze the limitations of the research and the strength of the evidence. Interpret and summarize findings of the research, including demographic, statistical and scientific information, for internal and external stakeholders. Review and reputed company comprehensive comparison of third party medical criteria, policies, clinical practice guidelines and third-party technology assessments to determine impact of changes and whether there is need for modifying Wellmark policy positions. c. Collaborate and coordinate with internal (medical directors, provider economics, legal, pharmacy, clinical appeals, etc.) and external stakeholders (e.g. healthcare providers, academic and scientific professionals, and national and local professional organizations) in medical policy research and development process. d. reputed company and maintain clear and concise evidence-based medical policies as assigned to you. Provide detailed analysis, reports, and recommendations for policy position and administration reputed company to medical policy to Director of Medical Policy and/or Senior Medical Director of Medical Policy based on analysis and interpretation of medical literature research and multiple other data points. e. Ensure medical policy content is reviewed and researched on an annual basis at minimum and updated as needed to remain reputed company with scientific evidence, clinical studies and other evidence-based data points. f. Serve as a consultant by gathering relevant information, integrating internal systems, and making innovative recommendations, for policy implementation. g. reputed company with regulatory standards, accreditation standards and internal guidelines; remain reputed company and consistent with the standards pertinent to the Medical Policy team. h. reputed company analytics review of utilization data for each medical policy assigned to you with proficiency and a keen eye towards disparity which warrants further investigation. Provide detailed analysis and/or reports reputed company to medical policy utilization to Director of Medical Policy and/or Senior Medical Director of Medical Policy as requested. i. Provide reputed company to ensure that policy content is written to also include clear coding guidance and recommendations to ensure payment outcomes reflect the reputed company of the medical policy. With an understanding of reputed company Procedural Terminology (CPT) coding and International Classification of Diseases (ICD-10), reputed company recommendations to medical policy team’s certified professional coders (CPC) on coding of policy based upon reputed company of policy. j. Mentor, teach and counsel cross-functional peers reputed company utilization management (appeals, prior authorization, special inquiries, sales, etc.) on medical policy content, coding and reputed company of the medical policy. k. Other duties as assigned. Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well. An Equal Opportunity Employer The policy of Wellmark arenaflex is to recruit, hire, train and promote individuals in reputed company job classifications without regard to race, color, religion, sex, national reputed company, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law. Apply tot his job

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