Clinical Policy Operations Professional 2

Job not on LinkedIn

🔥 4 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CenterWell Senior Primary Care

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

Healthcare Insurance

CenterWell Senior Primary Care is a healthcare provider focused on delivering personalized primary care to senior citizens. The company emphasizes a comprehensive and holistic approach to healthcare, addressing the physical, social, and emotional needs of older adults. As part of its service offerings, CenterWell includes home health services and pharmacy support to complement its senior primary care. The organization is committed to offering stability, inclusive benefits, and career growth opportunities for its employees while maintaining a culture of mutual respect and mindfulness. CenterWell is a brand under the larger healthcare entity, Humana.

📋 Description

• Provides operational support to clinical pharmacists for the implementation, maintenance, submission, and ongoing management of clinical policies, drug lists, and benefit requirements • Collaborates with healthcare professionals, pharmacists, and business stakeholders to operationalize clinical policy strategies • Performs quality analysis and reporting to ensure effective operational execution • Creates process and training documentation as appropriate • Interprets Medicare and state-specific Medicaid regulations, benefit requirements, and operational guidance to support accurate implementation and maintenance of state-specific clinical policies and utilization management strategies • Partners with clinical, operational, and business stakeholders to ensure clinical policy intent is accurately reflected in formulary structures, utilization management criteria, and system configuration • Participates in cross-functional initiatives to streamline policy implementation, workflow management, and operational review processes across clinical and operational teams

🎯 Requirements

• Bachelor's degree • Less than 5 years of technical experience • Strong collaboration and relationship-building skills • Excellent written and verbal communication skills • Excellent planning and organizational skills • Demonstrated ability to manage complex operational processes requiring a high degree of accuracy, attention to detail, and independent problem solving • Working knowledge of all Microsoft Office applications, including Word, Excel and Outlook • Ability to work on multiple, competing projects • Ability to successfully handle change in a fast-paced environment • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance