Medical/Clinical Policy Writer

🕒 September 16

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $72.2k - $115.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

✏️ Content Writer

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This company has sponsored H1B visas in the past.

👻 Ghost score 34%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Research and develop moderate to complex medical/clinical, behavioral health, and reimbursement policies • Ensure adherence to company, state, and federal guidelines • Support the operational processes of the Policy Governance Committee • Monitor status reports to ensure effective workflow and timely development of medical and pharmacy policies • Support internal departments and processes in policy and procedure development and implementation • Ensure medical policies comply with relevant regulations and remain consistent across lines of business • Participate in department initiatives and projects • Research clinical and scientific literature and consensus guidelines to create work products and inform the CPC • Create and update policy bibliographies • Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities • Provide policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products, and other markets as business needs change • Coordinate with subject matter experts on issues impacting CareSource • Monitor legislative and regulatory activities for potential impact on existing or proposed policies • Collaborate with interdisciplinary team members to achieve team goals • Perform other job duties as requested

🎯 Requirements

• Bachelor’s degree or equivalent years of relevant work experience is required • Advanced degree or equivalent education/degree in life sciences/healthcare is preferred • Minimum of two (2) years of healthcare-related writing experience preferred; clinical and managed care backgrounds preferred • Minimum of two (2) years of experience in medical policy development and/or implementation preferred • Strong presentation skills • Computer skills/proficiency with Microsoft Word, Excel, search engines, and bibliographic software • Knowledge of medical terminology and claims payment policies • Strong clinical expertise and healthcare administration understanding • Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature • Ability to interpret complex clinical information and apply to policy development • Excellent verbal and written communication skills • Presentation and decision-making skills • Excellent organization and tracking skills • Good problem-solving skills • Ability to interface with employees at all levels • Ability to handle multiple priorities/projects simultaneously • RN or equivalent clinical licensure preferred, or in lieu of licensure: 2 years clinical/medical policy writing experience or equivalent policy/healthcare experience • Knowledge of NCQA policy timely requirements • May require sitting/standing for long periods of time

🏖️ Benefits

• Bonus tied to company and individual performance • Comprehensive total rewards package • Virtual office opportunity (WFH) • Occasional travel to main office

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