Georgia Licensed Clinical Policy Manager

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

Key Responsibilities

Evaluate vendor policy sets for compliance with internal and external medical standards

Identify affordability opportunities within vendor policies and align with departmental strategies

Ensure streamlined vendor processes and support clinical initiatives across the organization

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 or clinical operations

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