Texas Licensed Policy Manager

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

Key Responsibilities

Track policy performance and identify areas for process changes to enhance affordability and efficiency

Develop internal tracking systems to organize projects across timelines and deliverables

Create evidence-based recommendations for policy modifications and maintain industry best practices

Required Qualifications

Bachelor's degree in a relevant field (e.g., B.S.Pharm, PharmD, PA, NP, APRN, BSN, or RN)

Active, unrestricted clinical license

4+ years of experience with clinical policy, particularly in health insurance

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

Working knowledge of medical and pharmacy coding and claims