Remote Healthcare Analyst – Policy Writer (RN) – Ohio

Job Overview

  • Clinical License RN
  • State(s) OH

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Under general supervision, creates and maintains health plan policies used in the clinical review process. Assists in researching new technologies presented to the plan for reimbursement consideration. Manages processes that assure policies used in medical necessity determinations remain compliant with National Committee for Quality Assurance (NCQA) requirements and guidelines from other professional organizations.

This position has the option to work fully remote; Cleveland, Ohio area residents preferred. 

Responsibilities

Healthcare Analyst- Policy Writer

  • Researches and analyzes evidence and background materials for creation of new or revised medical policies used by clinical operations in performing clinical review function; drafts medical policies and related summary documents based on research performed.
  • Performs specific research to assist in determining appropriate coverage of newly approved medical technologies including laboratory tests, medical devices, or other services. This research may include identification of specialty society positions, identification of regulatory findings specific to technologies, identification of coding specific technology, and assists in determining costs related to new and existing policies.
  • Researches questions and issues from internal physicians and nurses related to developed medical policies or other clinical issues arising from daily operations; Develops and delivers educational training regarding policies to clinical review teams.
  • Coordinates communication of medical policy decisions to necessary internal stakeholders and maintains accurate libraries of policies and related clinical summary documents.
  • Supports medical policy system edit decisions and development; Notifies appropriate parties of coding changes in new or updated medical policies.
  • Performs other duties as assigned.

Sr Healthcare Analyst- Policy Writer 

  • Researches and analyzes evidence and background materials for creation of new or revised typically more complex medical policies used by clinical operations in performing clinical review function; drafts medical policies and related summary documents based on research performed.
  • Performs typically more complex specific research to assist in determining appropriate coverage of newly approved medical technologies including laboratory tests, medical devices, or other services. This research may include identification of specialty society positions, identification of regulatory findings specific to technologies, identification of coding specific technology, and assists in determining costs related to new and existing policies.
  • Researches typically more complex questions and issues from internal physicians and nurses related to developed medical policies or other clinical issues arising from daily operations; Develops and delivers educational training regarding policies to clinical review teams.
  • Coordinates communication of medical policy decisions to necessary internal stakeholders and maintains accurate libraries of policies and related clinical summary documents.
  • Supports medical policy system edit decisions and development. Notifies appropriate parties of coding changes in new or updated medical policies.
  • Orients, trains, and assists more junior level staff.
  • Performs other duties as assigned.

Qualifications

Healthcare Analyst- Policy Writer 

Education and Experience

  • Bachelor’s Degree in Life Science, Nursing or related field. Master’s Degree preferred.
  • 2 to 3 years experience in nursing, research or related clinical area which includes organizational and project management experience.
  • Clinical research, analytics and writing experience preferred.

Professional Certification(s)

  • Certified professional coder preferred.

Technical Skills and Knowledge

  • Intermediate Microsoft Office skills.
  • Knowledge of healthcare system and factors that affect adoption and implementation of new and emerging healthcare technologies and procedures; Understanding of medical coding as it relates to diagnosis and procedures.
  • Strong verbal and written communication skills, including the ability to explain scientific principles concisely and accurately.
  • Knowledge of how to appropriately reference and attribute source material.
  • Ability to research and quickly synthesize volumes of information on health technologies and clinical trials in wide variety of clinical areas.
  • Ability to analyze financial data, understand trend and formulate recommendations on coverage under the medical plan.

 

Sr Healthcare Analyst- Policy Writer 

Education and Experience

  • Bachelor’s Degree in Life Science, Nursing, or related field. Master’s Degree preferred.
  • 5 years progressive experience as a Healthcare Analyst-Policy Writer or equivalent experience in nursing, research or related clinical area which includes organizational and project management experience.
  • Experience in health technology assessment and evaluation preferred.
  • Clinical research, analytics and writing experience preferred.

Professional Certification(s)

  • Certified professional coder preferred.

Technical Skills and Knowledge

  • Intermediate to expert Microsoft Office skills.
  • Thorough knowledge of healthcare system and factors that affect adoption and implementation of new and emerging healthcare technologies and procedures; Understanding of medical coding as it relates to diagnosis and procedures.
  • Excellent medical writing skills to write clearly and succinctly for a broad healthcare audience; Strong verbal and written communication skills, including the ability to explain scientific principles concisely and accurately.
  • Knowledge of how to appropriately reference and attribute source material.
  • Strong literature searching skills and ability to synthesize complex information; Ability to quickly synthesize volumes of information on health technologies and clinical trials in wide variety of clinical areas.
  • Ability to analyze financial data, understand trend and formulate recommendations on coverage under the medical plan.
  • Demonstrated human relations skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

  • We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
  • Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
  • On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
  • Discounts at many places in and around town, just for being a Medical Mutual team member.
  • The opportunity to earn cash rewards for shopping with our customers.
  • Business casual attire, including jeans.

Excellent Benefits and Compensation:

  • Employee bonus program.
  • 401(k) with company match up to 4% and an additional company contribution.
  • Health Savings Account with a company matching contribution.
  • Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
  • Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
  • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
  • After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

  • Career development programs and classes.
  • Mentoring and coaching to help you advance in your career.
  • Tuition reimbursement up to $5,250 per year, the IRS maximum.
  • Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Primary Location

 US-Ohio

Job

 7 – General Staff

Organization

 Sr Medical Officer Admin

Schedule

 Regular

Shift

 Standard

Employee Status

 Individual Contributor

Job Type

 Full-time

Job Level

 Day Job

Job Posting

 Jun 21, 2024, 9:46:39 PM

 

 

 

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