<h3>Job Summary:</h3><p>Medical/Clinical Policy Writer research and develop moderate to complex Medical/Clinical, BH, and Reimbursement policies; ensure adherence to company, state, and federal guidelines.</p><h3>Essential Functions:</h3><ul> <li>Support the operational processes of the Policy Governance Committee</li> <li>Monitor status reports to ensure effective workflow and timely development of medical and pharmacy policies</li> <li>Support internal departments and processes in the development and implementation of policies and procedures</li> <li>Ensure all medical policies are compliant with relevant regulations and are consistent across all lines of business</li> <li>Participate in department initiatives and projects</li> <li>Research clinical and scientific literature and consensus guidelines to create work products for team input and to inform CPC</li> <li>Create and update policy bibliographies</li> <li>Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities</li> <li>Provide medical/clinical, BH, and reimbursement policies policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products and other markets as business needs change</li> <li>Coordinate with subject matter experts to develop policy on issues that impact <a href="https://himalayas.app/companies/caresource">CareSource</a> from medical/clinical, BH, and reimbursement policies policy perspectives</li> <li>Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies</li> <li>Collaborate with interdisciplinary team members to achieve team goals</li> <li>Knowledge of NCQA policy timely requirements</li> <li>Perform any other job duties as requested</li> </ul><h3>Education and Experience:</h3><ul> <li>Bachelor’s degree or equivalent years of relevant work experience is required</li> <li>Advanced degree or equivalent education/degree in life sciences/healthcare is preferred</li> <li>Minimum of two (2) years of healthcare-related writing experience preferred; clinical and managed care backgrounds preferred</li> <li>Minimum of two (2) years of experience in medical policy development and/or implementation preferred</li> <li>Strong presentation skills</li> </ul><h3>Competencies, Knowledge and Skills:</h3><ul> <li>Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software</li> <li>Knowledge of medical terminology and claims payment policies</li> <li>Strong clinical expertise and healthcare administration understanding</li> <li>Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature</li> <li>Ability to interpret complex clinical information and apply to policy development</li> <li>Excellent verbal and written communications skills</li> <li>Presentation and decision-making skills </li>