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    Senior Medical Policy Analyst - Baltimore, MD, United States - Blue Cross and Blue Shield Association

    Blue Cross and Blue Shield Association
    Blue Cross and Blue Shield Association Baltimore, MD, United States

    2 days ago

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    Description

    Join Our Team as a Senior Medical Policy Analyst - RN (Remote)



    Are you an experienced professional looking to work remotely within the greater Baltimore metropolitan area? We've got an exciting opportunity for you!



    PURPOSE:

    In collaboration with the Medical Director, the Senior Medical Policy Analyst plays a key role in researching, analyzing, and developing medical policies and procedures to align with our corporate values and industry standards.

    The incumbent will also work closely with various teams to ensure effective implementation of these policies for seamless claims processing and utilization management.



    ESSENTIAL FUNCTIONS:
    • Maintains awareness of health and policy trends to develop new medical policies.
    • Writes evidence-based policies to ensure compliance with regulations and standards.
    • Leads discussions during committee meetings to provide clinical guidance on policy development.
    • Maintains the Medical Policy Reference Manual and ensures policy dissemination.
    • Supports and mentors team members.

    QUALIFICATIONS:

    If you hold a Bachelor's Degree in Nursing, Public Health, English, or a related field, along with 5 years of clinical experience, we'd love to hear from you!


    Licenses/Certifications:
    • Active RN - Registered Nurse license required.
    • Certified Coder (CCS or CPC) within 1 year required.

    Preferred Qualifications:
    • Master's degree in nursing or related field.
    • Experience in a health care payer organization.

    Knowledge, Skills and Abilities (KSAs):
    • Self-motivated with strong initiative.
    • Excellent written and verbal communication skills.
    • Knowledge of medical insurance and managed care principles.
    • Proficient in Microsoft Office applications.
    • Ability to meet deadlines and provide exceptional customer service.

    Salary Range:
    $69,768 - $138,567

    Explore this opportunity to work with us in a dynamic and rewarding environment!


    Equal Employment Opportunity:

    We are an Equal Opportunity (EEO) employer. We value diversity and provide equal employment opportunities to all applicants.


    Note:

    Applicants must disclose any event that may affect their eligibility to work on Federal health care programs.


    PHYSICAL DEMANDS:

    The associate's duties involve primarily seated work with occasional standing or walking. The role requires the use of hands for various tasks and occasional lifting up to 25 pounds.


    If you're looking to make a positive impact in the healthcare field, we invite you to apply for this exciting opportunity with us!

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