Director of Clinical Policy

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🔥 13 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🔴 Lead

👔 Director

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Integrated Home Care Services, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2015

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

Integrated Home Care Services, Inc. is an integrated home care benefits manager that coordinates and manages value-based home health services, durable medical equipment, and home infusion for patients and members on behalf of health plans and providers. It provides network development and credentialing, utilization management, claims adjudication, analytics, and a technology-enabled platform for referrals, real-time documentation, and 24/7 access to services, aiming to reduce costs, improve outcomes, and streamline administration for payers, providers, and patients.

📋 Description

• Responsible for leading the development, implementation, and continuous improvement of clinical policies, criteria, and workflows supporting home health and durable medical equipment (DME) services across all lines of business. • Ensure that clinical criteria are evidence-based, operationally efficient, and aligned with Medicare, Medicaid, and commercial payer requirements. • Partner closely with clinical operations, utilization management, technology, and product teams to design and optimize scalable, automated workflows.

🎯 Requirements

• Lead the development, standardization, and maintenance of clinical criteria for all home health and DME services across lines of business. • Translate Medicare (NCDs/LCDs), Medicaid, and commercial payer policies into actionable, operational clinical guidelines. • Maintain up-to-date knowledge of Medicare and Medicaid regulations, including coverage determinations, billing requirements, and policy updates. • Collaborate with Medical Directors, UM teams, care management, and provider engagement teams to ensure alignment of clinical policies and operational workflows.

🏖️ Benefits

• Medical • Vision • Dental • Short- and Long-term insurance • 6+ Days of Holidays Pay • 17 days of PTO • Employer paid life insurance • 401K with employer contribution • Wellness program with reward incentives • Employee recognition and reward programs • Comprehensive paid training program