State 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 departmental and organizational goals

Track deliverables to meet SLAs and TAT, and prepare materials for executive review and feedback

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, particularly in health insurance

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

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