Behavioral Health Medical Policy Analyst
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Job Description
Behavioral health policy analyst supporting Centene’s healthcare coverage decisions through evidence-based research, technical writing, and clinical policy maintenance.
Responsibilities:
- 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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