Clinical Policy Development Analyst

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Avalon Healthcare Solutions

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2013

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Avalon Healthcare Solutions is a company that provides Diagnostic Intelligence and lab benefit management solutions to health plans, labs, and providers. It offers a platform and services — including genetic test management, routine test and radiology management, curated lab networks, real-time test decisioning, evidence-based policies, and analytics — to reduce unnecessary diagnostic testing, control costs, and improve care quality. Avalon emphasizes science-driven, evidence-based approaches to manage growing diagnostic complexity (particularly genetic testing and oncology), delivering operational workflows and measurable savings for health plans and other healthcare organizations.

📋 Description

• Research emerging laboratory tests, technologies, clinical guidelines, coding changes, payer policies, and utilization trends • Identify and prioritize opportunities for new routine testing policies based on clinical evidence, market need, claims data, and potential client value • Review and summarize peer-reviewed literature, professional society guidance, CMS coverage requirements, and other authoritative sources • Draft clinical policies defining scope, medical necessity criteria, coverage requirements, exclusions, limitations, and supporting references • Present policy recommendations for clinical review and revise draft policies through approval and publication • Review the existing policy library for coverage gaps, outdated references, or opportunities to expand or consolidate policies • Maintain organized research, citations, decision records, and version-controlled policy documentation • Partner with Product, Scientific Affairs, Coding & Translation, and claims-editing teams to support policy implementation and answer questions about policy intent • Use approved AI and large language model tools to support research, policy comparison, and evidence synthesis while validating outputs against authoritative sources

🎯 Requirements

• Demonstrated ability to evaluate clinical literature and translate evidence into clear policy language • Familiarity with diagnostic testing, medical necessity, and health plan coverage policies • Strong research, analytical, writing, and documentation skills • Ability to manage multiple policy-development projects and work effectively across clinical, product, technical, and operational teams • Advanced clinical or scientific degree or relevant professional credential (preferred) • Experience developing clinical policies for a health plan, laboratory benefit manager, utilization management organization, or healthcare technology company (preferred) • Knowledge of routine laboratory testing, pathology, and diagnostic coding (preferred) • Familiarity with CMS NCDs and LCDs, commercial payer policies, and professional society guidelines (preferred) • Experience using claims data or AI-assisted research tools to identify and evaluate policy opportunities (preferred)

🏖️ Benefits

• Eligible for remote work • Quarterly travel required to Avalon’s corporate office in Tampa, Florida