Jobs
>
Baltimore

    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 weeks ago

    Default job background
    Description

    Medical Policy Analyst - RN (Remote)



    Resp & Qualifications


    PURPOSE:


    In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and accepted standard of medical practice.

    We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.


    ESSENTIAL FUNCTIONS:

    • Performs in-depth research on medical topics identified in existing medical policies and operating procedures scheduled for revision or updates based upon changes in the standard of care. Evaluates current peer-reviewed articles and other literature to determine its appropriateness of clinical guidance and mandated legislation in support of and inclusion in policies.
    • In collaboration with the Medical Director, revise evidenced-based medical policies and operating procedures in compliance with legislative mandates, contractual provisions, corporate philosophy, and accepted standards of medical practice in order for them to be applied uniformly and consistently across all lines of business.
    • Maintains the Medical Policy Reference Manual (MPRM) including resource files and publications. Ensures dissemination of medical policies and operating procedures to internal and external customers according to CareFirst application protocol and regulatory standards.

    QUALIFICATIONS:

    Education Level:

    Bachelor's Degree in Nursing, Public Health, English or related field directly related to the position OR in lieu of a bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.


    Licenses/Certifications Required:

    • RN - Registered Nurse - State Licensure And/or Compact State Licensure Registered Nurse (RN).
    • Certified Coder (CCS or CPC)-AHIMA or AAPC Certified Professional Coder (CPC) within 1 Year.

    Experience:

    • 3 years Clinical experience within the field of Medical Surgical, Mental Health, Durable Medical Equipment, and/or Utilization Management, including some experience in research methodology and systematic evaluation of medical literature and translation of evidence into policy in a healthcare setting.

    Preferred Qualifications:

    • Certified Professional Coder (CPC).
    Knowledge, Skills and Abilities (KSAs)


    • Ability to analyze essential facts, make timely and sound decisions, resolve performance and job-related issues. Demonstrated desire to share knowledge and work as a team.
    • Excellent written and verbal communication skills, and the ability to present to internal clients of all levels.
    • Working knowledge of medical insurance and managed care principles and knowledgeable of CPT and ICD-10 coding systems. Knowledge of all types of medical necessity decisions including various places of service and provider types.
    • Knowledge of principles, practices, evidence-based guidelines and standardized processes and procedures for evaluating medical support operations business practices.
    • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

    Salary Range:
    $64,224 - $127,556

    Salary Range Disclaimer


    The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed.

    This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration.

    It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.

    In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

    Department

    Medical Policy

    Equal Employment Opportunity

    CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.

    It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

    Where To Apply

    Please visit our website to apply:

    Federal Disc/Physical Demand

    Note:

    The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.


    PHYSICAL DEMANDS:
    The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

    Sponsorship in US

    Must be eligible to work in the U.S. without Sponsorship

    #LI-NH2
  • City of Baltimore, MD

    HR Policy Analyst

    2 weeks ago

    City of Baltimore, MD Baltimore, United States

    THIS IS A NON-CIVIL SERVICE POSITION · POSTING DATE: 04/15/2024 · CLOSING DATE: 07/15/2024 12:00 MIDNIGHT · Position Summary · Reporting to the Manager, Policy and Compliance, the HR Policy Analyst will provide support for policy development and implementation by researching and ...

  • State of Maryland

    Health Policy Analyst Advanced

    2 weeks ago

    State of Maryland Baltimore, United States

    **Introduction**: · **GRADE**: · 19 · **LOCATION OF POSITION**: · MDH - Office of Long Term Services and Supports · 201 W. Preston Street · Baltimore, MD 21201 · **Main Purpose of Job**: · The main purpose of this position is to research, develop, and implement high-priority, cro ...

  • US National Oceanic and Atmospheric Administration

    Policy Analyst

    2 weeks ago

    US National Oceanic and Atmospheric Administration Silver Spring, United States

    **Duties**: · **As a Policy Analyst, you will perform the following duties**: · - Develop and evaluate strategies for short · - and long-term planning of agency environmental satellite, data and information services policy formulation and evaluation in association with organizati ...

  • Baltimore City

    Policy Analyst

    1 week ago

    Baltimore City Baltimore, United States

    Policy Analyst (NCS) - Office of Equity and Civil Rights page is loaded · Policy Analyst (NCS) - Office of Equity and Civil Rights · Apply · locations · 7 E Redwood St · time type · Full time · posted on · Posted 3 Days Ago · job requisition id · R · THIS IS A NON-CIVI ...

  • Baltimore City

    Policy Analyst

    1 week ago

    Baltimore City Baltimore, United States

    Policy Analyst (NCS) - Office of Equity and Civil Rights page is loaded · Policy Analyst (NCS) - Office of Equity and Civil Rights · Apply · locations · 7 E Redwood St · time type · Full time · posted on · Posted 3 Days Ago · job requisition id · R · THIS IS A NON-CIVI ...

  • US National Oceanic and Atmospheric Administration

    Policy Analyst

    2 days ago

    US National Oceanic and Atmospheric Administration Silver Spring, United States

    **Duties**: · As a Policy Analyst, you will perform the following duties: · - Develop and evaluate strategies for short and long · - term planning of agency National Oceanic and Atmospheric Administration (NOAA) Corps policy formulation and evaluation in association with organiza ...

  • Sentar

    Cyberspace Policy Analyst

    2 weeks ago

    Sentar Annapolis Junction, United States

    Sentar is dedicated to developing the critical talent that the connected world demands to create solutions to address the convergence of cybersecurity, intelligence, analytics, and systems engineering. We invite you to join the small business team where you can build, innovate, a ...

  • Blue Cross and Blue Shield Association

    Medical Policy Analyst

    3 weeks ago

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

    Medical Policy Analyst - RN (Remote) · Resp & Qualifications · PURPOSE: · In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider an ...

  • Blue Cross and Blue Shield Association

    Medical Policy Analyst

    3 weeks ago

    Blue Cross and Blue Shield Association Baltimore, United States

    Resp & Qualifications · PURPOSE: · In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and accepted standa ...

  • CareFirst

    Medical Policy Analyst

    3 weeks ago

    CareFirst Baltimore, United States

    **Resp & Qualifications** · **PURPOSE:** · In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and accepte ...

  • Sentar

    Cyberspace Policy Analyst

    1 week ago

    Sentar Baltimore, United States

    Cyberspace Policy Analyst III - Careers At Sentar · Share with friends or Subscribe · Back To Openings · Cyberspace Policy Analyst - III · Location: · Annapolis Junction, MD · START YOUR APPLICATION · Sentar is dedicated to developing the critical talent that the connected ...

  • Sentar

    Cyberspace Policy Analyst

    1 week ago

    Sentar Baltimore, United States

    Cyberspace Policy Analyst III - Careers At Sentar · Share with friends or Subscribe · Back To Openings · Cyberspace Policy Analyst - III · Location: · Annapolis Junction, MD · START YOUR APPLICATION · Sentar is dedicated to developing the critical talent that the connected ...

  • Booz Allen Hamilton

    Cyberspace Policy Analyst

    1 week ago

    Booz Allen Hamilton Baltimore, United States

    Serve as a Cyberspace · Policy · Analyst providing analysis, recommendations, and strategic-level guidance to enable effective Cyberspace Operations at the National, DoD, Service, and Command levels.Gather information, provide analysis, and produce written products in support o ...

  • Dovel Technologies

    Scientific Policy Analyst

    1 week ago

    Dovel Technologies Baltimore, United States

    Scientific Policy Analyst page is loaded · Scientific Policy Analyst · Apply · locations · US - MD, Rockville · time type · Full time · posted on · Posted 3 Days Ago · job requisition id · 17870 · Job Family : · Scientific Research & Analysis (Digital) · Travel Requi ...

  • Blue Cross and Blue Shield Association

    Medical Policy Analyst

    3 weeks ago

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

    Medical Policy Analyst - RN (Remote) · In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and accepted st ...

  • Blue Cross Blue Shield companies

    Medical Policy Analyst

    1 week ago

    Blue Cross Blue Shield companies Baltimore, United States

    Medical Policy Analyst - RN (Remote) · Resp & Qualifications · PURPOSE: · In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider ...

  • Booz Allen Hamilton

    Cyberspace Policy Analyst

    1 week ago

    Booz Allen Hamilton Baltimore, United States

    Serve as a Cyberspace · Policy · Analyst providing analysis, recommendations, and strategic-level guidance to enable effective Cyberspace Operations at the National, DoD, Service, and Command levels.Gather information, provide analysis, and produce written products in support o ...

  • Booz Allen Hamilton

    Cyberspace Policy Analyst

    2 days ago

    Booz Allen Hamilton Baltimore, United States

    Job Number: R · Cyberspace Policy Analyst · Key Role: · Serve as a Cyberspace · Policy · Analyst providing analysis, recommendations, and strategic-level guidance to enable effective Cyberspace Operations at the National, DoD, Service, and Command levels.Gather information, p ...

  • Blue Cross and Blue Shield Association

    Medical Policy Analyst

    3 weeks ago

    Blue Cross and Blue Shield Association Baltimore, United States OTHER

    Medical Policy Analyst - RN (Remote) · Resp & QualificationsPURPOSE:In collaboration with the Medical Director, the Medical Policy Analyst will research, analyze, evaluate, and revise medical policies and operating procedures to support the corporate philosophy, provider and memb ...

  • Blue Cross and Blue Shield Association

    Senior Medical Policy Analyst

    3 weeks ago

    Blue Cross and Blue Shield Association Baltimore, United States

    Resp & Qualifications · PURPOSE: · In collaboration with the Medical Director, the Senior Medical Policy Analyst will research, analyze, evaluate, revise, and develop medical policies and operating procedures to support the corporate philosophy, provider and member contracts, and ...