Behavioral Health Medical Policy Analyst

Job not on LinkedIn

🔥 4 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Assist the Chief Medical Director, Medical Management and Utilization Management Operations with technical writing and research related to clinical practices, policies, guidelines, and technology assessments • Conduct research using evidence-based criteria and authorization rules to support clinical decision making • Assist with technical assessments of new medical technologies and procedures • Help provide full disclosure of medical policies to members and providers through web portals and provider manuals • Conduct research for the Special Investigations Unit to identify fraud, waste, and abuse • Provide research and criteria to support legal proceedings regarding clinical policy • Work with claims, configuration, and claims dispute teams to ensure proper implementation of medical policy in the claims system • Track timelines and update clinical policies to meet compliance, state, federal, and accreditation requirements • Support annual and as-needed updates to Clinical Coverage Guidelines, Claims Edit Guidelines, and Clinical Practice Guidelines • Maintain and track issues concerning medical, pharmacy, and behavioral health policy development and maintenance • Support governing committees, including the Medical Policy Committee and Claims Payment Policy Committee • Participate in cross-functional teams addressing key clinical policy issues • Perform other duties as assigned

🎯 Requirements

• A Bachelor's Degree in Medical Technology, Life Sciences or other related field or equivalent experience • 3+ years of experience in healthcare, analysis, technical writing, or health administration • Experience in writing technical publications in the healthcare field • Registered Nurse (RN) preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation

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