Senior Medical Policy Research Consultant

Responsibilities

• Develops medical policies for BCBSMN, and assure that changes in medical policies and supporting rationale are communicated to all lines of business, including Medicare, internal stakeholders and others as needed.
• Presents medical policy recommendations and supporting rationale to BCBSMN’s Medical and Behavioral Health Policy Committee, Coverage Committee (executive-level committee), and other key groups.
• Participates as a team member in internal BCBSMN technology assessment committees.
• Serves as internal consultant to Medical Directors and staff on emerging medical technology issues.
• Serves as external consultant to providers, vendors, manufacturers, government agencies and other organizations on the technology evaluation and medical policy processes.
• Participates in BCBSMN efforts to respond to regulatory and accreditation requirements (e.g., NCQA accreditation).
• Researches and analyzes scientific literature and medical policies around a clinical field to develop an organized, strategic approach taking into account the business integration into the policy development process.
• Manage medical policy-related projects.

Requirements

• 5+ years of related professional experience.
• Knowledge of medical literature and technology assessment evaluation methods.
• Demonstrated ability to analyze findings from the current medical literature and develop written conclusions regarding medical technology assessment in the areas of: clinical effectiveness, measurable health outcomes, and safety and appropriateness.
• Knowledge of local and national health care environment and trends.
• Ability to work independently, and deliver a product that is defensible before internal and external stakeholders.
• Ability to effectively communicate the results of research to multiple audiences in both verbal and written forms.
• Excellent interpersonal skills.
• Must possess the ability to build and maintain relationships with internal stakeholders, clinicians, regulatory agencies and others.
• Project Management experience.

Qualifications

• All relevant experience including work, education, transferable skills, and military experience will be considered.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Skills

• Bachelor's or Masters degree in a health related field with 5 years experience working in a health care environment (e.g. health care policy or clinical guidelines development).
• Knowledge of CPT and ICD-9 coding helpful.

Benefits

Pay Range: $90,800.00 - $120,300.00 - $149,800.00
Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We Offer a Comprehensive Benefits Package Which May Include Medical, dental, and vision insurance,
Life insurance,
401k,
Paid Time Off (PTO),
Volunteer Paid Time Off (VPTO), and more.
To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Contact Information

To discover more about what we have to offer, please review our benefits page.
For questions or concerns, please contact us at: talent.acquisition@bluecrossmn.com.