Clinical Policy Development Analyst

Job not on LinkedIn

🕒 October 8

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 11%

What it means: the chance that no one is really hiring for this job.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

☁️ SaaS

⚕️ Healthcare Insurance

Healthcare • SaaS • Healthcare Insurance

Avalon Healthcare Solutions is a healthcare technology company that provides a Diagnostic Intelligence platform and benefit-management services to health plans, labs, and providers. Using evidence-based policies, real-time test decisioning, curated lab networks, automated workflows, and analytics, Avalon manages and optimizes diagnostic testing — including genetic testing, oncology (liquid biopsy), cardiometabolic, and routine labs — to reduce waste, speed care, and improve outcomes. The company focuses on lab benefit management, precision genetic test management, and analytics to deliver measurable savings and operational oversight for payers and diagnostic partners.

📋 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and revise draft policies through approval and publication • Review the existing policy library for coverage gaps, outdated references, or opportunities to expand or consolidate policies • Maintain organized research, citations, decision records, and version-controlled policy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 to Avalon’s corporate office • Equal Opportunity Employer – Vet/Disability

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