Remote- Med Policy Developer/Research Specialist II
Pride Health · Phoenix, AZ · 4 wk ago
On-siteInformation Technology$35–$39/hrFull-time
About the role
Pride Health is hiring a Remote Medical Policy Developer/Research Specialist Nurse for a 6 month contract to hire position. The schedule is Monday-Friday from 8am-5pm.
Responsibilities
- Perform medical technology research related to coverage guidelines and new technology and provide evaluation and summarization to Medical Director Staff and/or Medical Policy Panel
- Develop and revise coverage guidelines and criteria as requested by management, Medical Director staff or Medical Policy Panel
- Participate as a contributing member on the Medical Policy Panel providing medical policy issues for discussion and, as required, on the Clinical Coding Governance Committee (CCGC)
- Maintain a thorough knowledge of all company medical coverage guidelines and other policies, such as Client Association Medical Policy Reference Manual, MCG care guidelines and/or Change Healthcare InterQual, and eviCore criteria
- Facilitate external consultant reviews concerning a coverage guideline or new technology
- Initiate the consultation and provide a summarization concerning the external review to the requestor
- Provide arrangements for appropriate reimbursement for the consultant’s review
- Communicate medical policy information in protocol format to healthcare providers upon request
- Perform basic level of code review with moderate assistance and review by management
Requirements
- Nursing License (LPN, RN, APRN)
- Utilization Review experience
- Experience working for a health plan
- Enjoy writing and extensive research
- Experience with policy development is a plus
Qualifications
- Nursing License (LPN, RN, APRN)
- Utilization Review experience
- Experience working for a health plan
- Enjoy writing and extensive research
- Experience with policy development is a plus
Skills
- Policy Development
- Medical Technology Research
- Medical Coverage Guidelines
- Clinical Coding Governance
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Qualifications
- Nursing License (LPN, RN, APRN)
- Utilization Review experience
- Experience working for a health plan
- Enjoy writing and extensive research
- Experience with policy development is a plus
Skills
- Policy Development
- Medical Technology Research
- Medical Coverage Guidelines
- Clinical Coding Governance
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Qualifications
- Nursing License (LPN, RN, APRN)
- Utilization Review experience
- Experience working for a health plan
- Enjoy writing and extensive research
- Experience with policy development is a plus
Skills
- Policy Development
- Medical Technology Research
- Medical Coverage Guidelines
- Clinical Coding Governance
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Qualifications
- Nursing License (LPN, RN, APRN)
- Utilization Review experience
- Experience working for a health plan
- Enjoy writing and extensive research
- Experience with policy development is a plus
Skills
- Policy Development
- Medical Technology Research
- Medical Coverage Guidelines
- Clinical Coding Governance
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Qualifications
- Nursing License (LPN, RN, APRN)
- Utilization Review experience
- Experience working for a health plan
- Enjoy writing and extensive research
- Experience with policy development is a plus
Skills
- Policy Development
- Medical Technology Research
- Medical Coverage Guidelines
- Clinical Coding Governance
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Benefits
- Comprehensive healthcare coverage (medical, dental, and vision plans)
- Supplemental coverage (accident insurance, critical illness insurance and hospital indemnity)
- 401(k)-retirement savings
- Life & disability insurance
- Employee Assistance Program
- Legal support
- Auto, home insurance, pet insurance
- Employee discounts with preferred vendors
Pay
$35-39/hour
Schedule
Monday-Friday (8am-5pm)
Qualifications
- Nursing License (LPN, RN, APRN)
- Utilization Review experience
- Experience working for a health plan
- Enjoy writing and extensive research
- Experience with policy development is a plus
Skills
- Policy Development
- Medical Technology Research
- Medical Coverage Guidelines
- Clinical Coding Governance
Benefits
- Comprehensive healthcare