Licensed Clinical Policy Manager

A company is looking for a Manager, Clinical Policy to join their Clinical Policy team.

Key Responsibilities

Clinically evaluate vendor policy sets to ensure compliance with internal and external standards

Vet vendor policy sets for affordability opportunities aligned with organizational goals

Ensure vendor processes are standardized and support departmental strategies

Required Qualifications

Bachelor's degree in a relevant field (PA, NP, APRN, BSN, or RN)

Active, unrestricted clinical license

4+ years of experience in clinical policy development or evaluation

4+ years of experience in utilization management and / or clinical operations

Working knowledge of medical coding (CPT, ICD-10, HCPCS) and claims